1226 W CRONE AVE, B & C6
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Anaheim Union High School District �L)�Z�LZ J
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
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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:
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Anaheim Union High School District ('
OWNER INFORMATION:--�77 [ores
Name: L L c Ci
Address: a A c--- t�q/
Phone Number: Home { 71 y �Tyz a? Y k� , Cell( %/cj(�3 sue— % 2 a
PLICANT INFORMATION: /
Name:_ C z
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aL-Gi
Phone Number: Home (%1y) J / Z)- 3y � -f) Cell ("7J�
PROPERTY INFORMATION:
Pro'ectAddress:1 �j k (,(� ('�r—�)� {i✓t7 �i1Ot C
2-D- e A, Cm-, �1aB
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: ,
COMMERCIAL:
Total Square
RESIDENTIAL: // l '
�o
Footage:
Total Square Footage: o
Multiplied by Current Rate
Elem
Multiplied by Current Rate �'395 /
= $
Elem. $'�7' $
.S. $ = $
H.S. 3 70? _ $ �•S
Equals To ee: $ = $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived:( ) Yes No If yes, reason:
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In above respresentations as to square footage are true, Developer/Applicant agrees that if it is later determined that such respresentations
e not true, Certificate shall automatically terminate the appropriate shall be notified.
Developer/Applicant Signature: Z C
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53090 and
65995.
Date entatjve - Anaheim Union High School District
ACTUAL FEES PAID: 1� /�
$ 2i / 9 S Check No. 17-5
/
Anaheim Union H.S. Dist. $ :Z j 792- 5 2 Check No. o�✓� 7�
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department