1218 S GAYMONT ST, BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-5454
CERTIFICATE of COMPLIANCE �6bs .
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 $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
S,
naheim Union High School District !
OWNER INFORMATION:
Name: Q L.A
Address: 111t S. o0T ST- TNAM"Of-1Nh 921E"ctf
Phone Number: Home Cell (-7)q)
APPLICANT INFORMATION:
n
Name: , 10 le�JE RV I ILIA,
Phone Number: Home ( ) Cell (314) �7�T7 3
PROPERTY INF..QRMATIQN:
Project Address: I'D YS MO KI T RM RNF') m '0A `I Z$ 0l
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments If of units:
Project Name: NDU
C>Cument
RESIDENTIAL:
otage:
Total Square Footage:
Mte
lem. _ $
Muhipiled by Current Rate /' 2�
Elem. $ � = $ ( 3
.S. $ =$
H.S.E_
$
Equals Total Fee: $_ $
FEE WAIVER:
Fees Waived: ( ) Yes ) No If yes, reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage are tm veloper/Applicant agrees that if It is later determined that such respresentations
are not true, Certificate shall automatically 'na a d the approp City/Ggpnty shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
//
Date Represen ive - naheim Union High School District
ACTUAL FEES PAID:
m --a:> t:�' $ Check No. 060
_
Anaheim Union H.S. Dist. $ �T 93 . (� Check No. d CO
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department