913 S IRA CT BIM
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-350
(714) 999-5454 '60� 1 —N
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
began at the time your project was approved (A
County as a condition of approval for your project, and you have received the requisite notice, the 90-day protest period
of Developer Fees per Gov. Code § 66023; (3) You
returned check (NSF) Is subject to a $30.00 administrative fee); (2) you have the right to request an audit
Districts Board meeting to review the Developer Fees Annual Report; and (4) The Developer Fees Annual
have the right to file a written request for mailed notice of the
Report and supporting documents are available at: httos //www auhsd usiDisWcLrDepartment/14195-Facilities.
RECEIPT NO.: ELEMENTARY DISTRICT: HIGH SCHOOL DISTRICT: nn
naheim Union High School District
OWNER INFORMATION: n
Name:
Address
Cell('?/) 5Y8 LSD {
Phone Number: Home( )
APPLICANT INFORMATION:
Name:
Phone Number: Home ( ) Cell ( )
PROPERTY INFORMATION:
Project Address: UK
Development Type: ('p) Residential -New ( ) Room Addition ( ) Commercial:
( ) Single Family Multi -Family Condos/Apartments # of units:
Project Name: tN�
i COMMERCIAL:
RESIDENTIAL: ! �9
Footage: to
Total Square Footage:
Total Square
Multiplied by Current Rate
Multiplied by Current Rate
•�'�--=5��r7/�J'•s/
Elem. =5
Elem.$
H.S. 5 �•5&� = s O 93.5
$ = s
Equals Total Fee: $��
Equals Tot : $ = $
i FEE WAIVER:
Fees Waived:( ) Yes ) No If yes, reason:
7 €KN tEEiO�,
....
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 shal automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
3 CERTIFICATION:
This certifies that the above named Develper/Applicant has paid school facility fees in compliane with Government Code Sections
53080 and 65995.
R to a -Anaheim Union High School District
Date
9 ACTUAL FEES PAID: t�
3,0t>3 • Check No.
Anaheim Sion H.S. Dist. $ 3� in'73 . S f> Check No. 'Z