876 S CLEMENTINE ST, B1
3
11
5
7
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Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
1,&D7,C)22- colDqL1
CERTIFICATE of COMPLIANCE t�sz
PAYMENT of SCHOOL FACILITY FEES 6Ut)- )22 -01L) aS
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 $30.00 administrative fee.
RECEIPT NO.:
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ELEMENTARY DISTRICT:
I AE_e>a�:.
HIGH SCHOOL DISTRICT:
Anaheim Union High School District
i E" I
OWNER INFORMATION:
Name:
Address:
Phone Number: Home ( ) Cell (630) 22-0
APPLICANT INFORMATION:
1
Name: P T -:x- G (C C-
Phone Number: Home
PROPERTY INFORMATION:
Project Address:'�+6 Sr �LG i''"l�N� l'�� �T•i � ��+�J'�Cp�g2.��
Development Type: ( ) Residential -New (-) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:RESIDENTIAL:
Footage: �✓
Total Square Footage:
Total Square
Multipiled by Current Rate
Multiplied by Current Rate
Elem.
E _$
H.S. $ _ $
H.S. .� $
Equals Fee: $ = $
Equals Total Fee: $ � _ $
'
k
FEE WAIVER:
Fees Waived: ( ) Yes ( o If yes, reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage ar o er/Applicant agrees that if it is later determined that such respresentations
are not true, Certificate shall automatically ter in a an ro tified.
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
ck�\l ;�z�
Date Repr ati -Anaheim Union High School District
ACTUAL FEES PAID: �y
Arz�5$ �• a-• �3 Check No. Ice-06
Anaheim Union H.S. Dist. $ oe ?Szo Check No. DLO
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department