242 E NARDA ST, BAnaheim 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:
Anaheim Union High School District
OWNER INFORMATION:
Name:
Address: GY a 2 oS
Phone Number: Home lq) Cell ( j
APPLICANT INFORMATION:_
Name: GSe vLo-
Phone Number: Home ( ) Cell (71y) O
PROPERTY INFORMATION:
11
Project Address:
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: VZ:I& .
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage: 7
Multiplied by Current Rate
Elem. $ _ $
Multiplied by Current Rate ��
Elem. S; -i = $
H.S. $ = $
H.S. 5= $ I, D.SI� • Z D
Equals Total Fee: $ = $
Equals Total Fee: $ = $ /?• 'YQ
FEE WAIVER:
Fees Waived: ( ) Yes (t/) 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 appr priate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Dev per 1' nt has paid efi0o, facility fees in compliance with Government Code Sections 53080 and
65995.
/D
Date R presentative -Ana ' Union High School District
ACTUAL FEES PAID: /,O
.A F S� $ ,- 1' � Check No. oI62QLV 45'85(e0/t,
Anaheim Union H.S. Dist. $ 7 JC6, 24 Check No. O(oWD959i' aCJr
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department