569 S GROVE AVE Bmnanelm union nfgn acnooi ulstnct
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE 13LD'Loi4-03sv
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 $30.00 administrative fee.
RECEIPT NO.:
HIGH SCHOOL DISTRICT: KA
Ir _
3Z-
JELEMENTA,RYDISTRICT:
Anaheim Elementary
Anaheim Union High School District (AUHSD)
�W
School District (AESD)
OWNER INFORMATION:
Name:
Address: 56 °C S '1 r .i2 Eve 017u
Phone Number: Home( ) Cell (r?14) Z40
APPLICANT INFORMATION:rt�` j
�
Name: .�Utl�thv�� �CtA+t�v`� w �.
Phone Number: Home ( ) Cell (-1tL0 q
PROPERTY INFORMATION:
Project Address: 569 S. GROVE AVE. JB ANAHEIM, CA
Development Type: ( X) Residential - New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments p of units:
Project Name: DET GC ADO
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
599
Total Square Footage:
Multiplied by Current Rate
Multipiled by Current Rate
Elem.$ =$
Elem.$ 2.585=$ $1,548.42
H.S. $ 2.585=$$1,548.42
Equals Tota :$ _$
Equals Total Fee:$ _$
FEE WAIVER:
Fees Waived: ( ) Yes (X) 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 respresentatlons
are not true, Certificate shall automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid s facility fees in compliance with Government Code Sections 53080 and
65995.
11 / Z'I / Z-'k
Date resentative - Anaheim Union High School District
ACTUAL FEES PAID:
1.Anaheim Elementary $1,548.42 Check No.�-
School District (AESD)
$1,548.42 1511945 %3
2. Anaheim Union H.S. Dist. --� Check No.
AUHSD
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department
2021.=