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Anaheim Union High School District o2S3':)
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE
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 $30.00 administrative fee.
RECEIPT NO.: ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
L `J Sb
Anaheim Union High School District
OWNER INFORMATION: e
Name:"WIM ?AgDd-1 L.L C LID YIM414 kMe,S
Address: 751 1Z Pat�7J�I Dr.. 1�l/I F2e Ui V-1c ?
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Phone Number: Home ( ) Cell (Iy j 9--7y -0 7 y.b
APPLICANT INFORMATION:
Name: j1'1 a:f
Phone Number: Home ( ) Cell (q j$ 3-71-0 7 y 6
PROPERTY INFORMATION:
-7 let )'v) -S 101
Project Address: "_3 1 f
yJ t-7NT4o jyj
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos partments # of units
Project Name: Oyu/ a a,Q'i'lit// Sew
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage: -ko 2
Muhipiled by Current Rate
Muhipiled by Current Rate
Elem. $ _$
Elem.$
Equals Tota = $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes No If yes, reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true, Developer/Applicant agrees that if it is later determined that such respresentations
are not true, Certificate shall automatically terminate and the, appropriate City/County shall be notified.
C' ✓�'t�/jam
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facilityfees in compliance with Government Code Sections 530g0 and
65995.
Date Repres tive Anaheim Union High School District
A UAL FEES PAID•
\ Check No.
Anaheim Union H.S. Dist. $ /, 7 . Check No. C_0 3
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department