846 N WEST ST$l/t72CSL2-U UU�h
Anaheim Union High School District
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 $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
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AD
Anaheim Union High School District (�
OWNER INFORMATION: jj ) 1� -1
Name: V lC
Address:' S,�� GhurL. S ��B-)N
Phone Number. Home(jlLA) Cell(11y) 4igR qI on 3
APPLICANT INFORMATION: —
Name: i i '�
Phone Number: Home (I ltl$mil (P 33 Cell (') L4)
PROPERTY INFORMATION:
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Project Address: s Lup I � t V v es l � `J 1 P nq K-L i VL Cq J a 01
Development Type: Residential - New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments tt of units:
Project Name:
MMERCIAL:
I
RESIDENTIAL:
Total Square Footage:
Total Square Footage: �� 34,Q
ltipiled by Current Rate
EI _$
[Equals
Multipiled by Current Rate //����� ��. 3lrp • /a
Elem.$O� =$
H.S. $ =$
r>�
H.S. S$ ��. �iD7S•/Z
T Fee:$ _$
Equals Total Fee:$ _$
FEE WAIVER:
Fees Waived: ( ) Yes ( )dNo If yes, reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage rue per/Applicant agrees that if it is later determined that such respresentations
are not true, Certificate shall automatically ter in a the Coun shall be noti
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 Rep a tive -Anaheim Union High School District
ACTUAL FEES PAID: n
�A iieS Check No. I g37
Anaheim Union H.S. Dist. $ Check No. ✓ .��
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department