2500 W CLEARBROOK LN14
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Anaheim Union High School District %%AOW
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:
(P12C�
Anaheim Union High School District
OWNER INFORMATION:
Name: -H I) �r ✓O
Address: Z= 1A) C ejn,- t2m V_ IV)
Phone Number: Home (aqq) 239 94 Lq Cell ( )
`PPLICANT INFORMATION:
Name: G (AN & V O
Phone Number: Home(-f14) 3-9} -'O!a-4 Cell( )
PROPERTY INFORMATION:
Project Address: Zip Vii C lea'Arw le IV,
Development Type: (>c.1 Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:
RESIDENTIAL: �47q
Total Square Footage:
Total Square Footage:
Multiplied by Current Rate
Elem. $ = $
Multiplied by Current Rate �]
Elem. $ - ` = $ a. r P
H.S. $ = $
�71
H.rS� $�� $ �Ji"; 7'/�
Equals Total Fee:$ =$
Equals Total Fee: $ �J =$/� f�1 tp7
Y�
FEE WAIVER:
Fees Waived: ( ) Yes ( ) No If yes, reason: -
ACKNOWttDGEMENT:
he 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 appro riate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant ha id school facility fees m compliance with Government Code Sections 53080 and
65995.
a a3
Date Representative - Anaheim U Igh S 001 District
ACTUAL FEP PAID: _�/ �-
'j
$ 02 /3•�� Check No.
2
Anahei Union H.S. Dist. $ Check No.
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department