120 N. BERNICE DRAnaheim Union High School District5(?2 Crescent Wdy,P,0.Box 3520,Anaheim,
(714)999-5454
UNLIMITED RECEIVED
MAY 0 9 2022VttUCA92803-3520
CITY OF ANAHEIMplanning&BUILDING DEPARTN€NTCERTIFICATEofCOMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE:The 90*day period in which you may protest the fee described herein will begin on the date this fee is paid.However,if the fee was
imposed by the City or County as a condition of approval for your project,and you have received the requisite notice,the 90-day protest period
began at the time your project was approved.Returned checks (NSF)are subject to a $30.00 administrative fee.
HIGH SCHOOL DISTRICT:
Anaheim Union High School District
ELEMENTARY DISTRICT:RECEIPT NO.:sA1
OWNER INFORMATION:
Name:
Address:('2o>hO -DiK2
0ii)MHZ-2fL2}LCellPhoneNumber:Home (
APPLICANT INFORMATION:</hvie /feName:3
Cell(Phone Number:Home(
PROPERTY INFORMATION:
SninB ^/r^oBEProjectAddress:
Development Type:()Residential -New
()Single Family
{/^"T^s’dentlal -Room Addition
()Multi-Family Condos/Apartments #of units:
4 ()Commercial:
Project Name:
RESIDENTIAL:COMMERCIAL:
Total Square Footage:
Muhipiled by Current Rate
(pl3
-%L i-x.
Total Square Footage:
Multiplied by Current Rate
Elem.$=S5El
H.S.=$H.S.$
=SEqualsTotalFee:$=SEquals;P<rt^Fee:$
FEE WAIVER:
Fees Waived:()Yes6 If yes,reason:No
7ACKNOWLEDGEMENTS
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
not true,Certificate shall automatically terminate and the appropriate CitVCouncy^
7 are
Developer/Applicant Signature:
CERTIFICATION:
certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 andThis
6S995.
8
ReprfeseQtati^-Anaheim Union High School DistrictDate
AaUAL FEES PAID:
V|g3j^
Anaheim Union H.S.Dist.
Check No.
Check No.
$3 $
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department