564 S BARNETT ST1
7
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-5454
1)U01614-0131(0
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
4
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:
1 (X2(
I �jD
Anaheim Union High School District
"NER INFORMATION:
Name: r-a4/ iv C v r r C JZ C- 2.
Z Address: -j CI 1 S , /-!/1,iV 6 Tr s i AAlg'wrl , Cn ; ?-g 0 .S
Phone Number: Home ( I Cell (1/14) 3 31 —A-1 6 6 Q
— APPLICANT INFORMATION:
3 Name: r-42/�)A C� i,' I Ef2�EZ
r- -
Phone Number: Home (71AP `3 3 1^ L/ 6 6 Cell (1 1w 3 3 y- 4 6 6 Y
PROPERTY INFORMATION-
Project Address: S 6y, S,'bQr2A1'1-T S T f4JVPH6 IM GP 2- $ 0 ,�
Development Type: ( } Residential - New ✓ Residential - Room Addition P YP ( ) ( )Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments ff of units:
Project Name:
COMMERCIAL:
Total Square Footage:
RESIDENTIAL:_
Total Square Footage:
M ultipiled by Current Rate
Elem. $ =$
Multipiled by Current Rate 7 Op nn
Elem. $
H.S. $ =$
H.S. $ r S =$
-'
Equals Total Fee: $ = $
Equals Total Fee: $>�— = $
FEE WAIVER:
Fees Waived:( ) Yes ( I No If yes, reason:
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 termin a and the appropriate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53M and
65995.
17 24
Date Representative - Anaheim nion Hi h School District
ACT,IUAL FEES PAID:
AE-SD $ off. el Check No. 3UY bit
Anaheim Union H.S. Dist. $ ' � Check No. �/) R40 k'�
Distribution: Developer/Appliant, AUHSD Accounting Department, Elementary School District Accounting Department