230 N BIRCHER ST BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-350
(714) 999-5454
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICES: (1) 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 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 (A
returned check (NSF) is subject to a $30.00 administrative fee); (2) you have the right to request an audit of Developer Fees per Gov. Code § 66023; (3) You
have the right to file a written request for mailed notice of the District's Board meeting to review the Developer Fees Annual Report; and (4) The Developer Fees Annual
Report and supporting documents are available at: https://www.auhsd.us/District/Department/14195-Facilities.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT: ��
C ,�
D END
Anaheim Union High School District
O NER INFORMATION:
Name: I Ahl EH 841
Address: 2 Z rti N. i c {xo� /�t1A�t0� mT r k ITZ. 01
Phone Number: Home (7j4) .1—W— Cell( ) 1(4 J—PP—yU3t<
lICANT INFORMATION:
Name: L A—td rj—f m\)
�p 9
Phone Number: Home ( Cell ( `7 (QE + �q 0H
PROPERTY INFORMATION: a30
Project Address: 1 in
Development Type: (y) Residential -New ( ) Room Addition ( ) Commercial:
( ) Single Family Multi -Family Condos/Apartments q of units:
Project Name: %� 1�1.t
COMMERCIAL:
R SIDENTIAL:
Total Square Footage:
Total Square Footage: %!L
Multipiled by Current Rate
Multiplied by Current Rate /- �%
Elem. $>
�$ / �//
Elem. $ _ $
��j
H.S..��$��c-F
Equals Total = $
Equals Total Fee: $ = $
FEE WAIVER:
Fees Waived: ( ) Yes (' No If yes, reason:
AiCtNOWLEDGEMENTS:'
The above respresentations as to square footage are true, Develper/Applicant agrees that if it is later determined that such
respresentations are not true, Certificate shall automatically terminate and the appForiate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Develper/Applicant has paid school facility fees in compliane with Government Code Sections
53080 and 65995.
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Date Repr i -Anaheim Union High School District
ACTUAL FEES PAID: /� i C'
$ �. 7 b s6. 2-t, Check No. -3 7 yt)0/ 8� _
Anaheim Union H.S. Dist. $ 0%�� �l P Check No. ✓� yyao i 99
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