3101 W. Vallejo Dr.
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Anaheim Union High School District
501 Crescent Way, P.O. Box 3520. Anaheim, CA 92803-3520
(714) 999-2188
(714) 520-5741 FAX
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CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The gO-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 gO-day protest period began at the time your project was approved.
ReAiPt N~~ ..... Elementa~+A~:..J High School District:
'~rJi Anaheim Union High School District
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Owner Information: ~lat~E"'~r"~'
Name:
Address:
Phone Number: (
Applicant Information: ~
Name: 'V.Jl-y'M- ~
Phone Number: ( ) .,
Property Information: t6:~ ....
Address of Project: a...LJ ~~ -
Development Type: [ ] Residential - New r ] Residential - Room Addition r ] Commercial
Project Name:
Type: r ] Single Family r ] Multi-Family Condos/Apartments - # of units:
Commercial: Residential:
Total Square Footage: r ] Level 1 r ] level 2 . ACSD Only ~] Level 3- A.CSO Only
Multiplied by Current Rate: Elem. $ =$ Total Square Footage: ' )i~
H.5. $ =$ Multiplied by Current Rate: Elem. $ //~ $ f'P?c?-,/O
Equals Total Fee: $ -$ H.S. $ / /~ $ 7,;t,.? <',16
Equals Total Fee: $ ~:oZ 'I - $/~R6
fee Waiver: .
Fees Waived: r ] Yes ry No If yes, reason:
Acknowledgement:
The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined that such
representations are not true, Certificate shall automaticaiiy terminate and the appropriate City/County shaii be notified.
Developer/Applicant Signature: \ , LL. 'ff.l7?0).n#7~
Certification: .-
This certifies that the above named Developerl Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
7-S~~ ~~- ~)~
Date Representative - ~naheim Unio High School District
Atz Fees Paid' . $ 70(~. </6 Check No. <:.;? 3
v-L-J~-'t.../
Anaheim Union H.S. District $ 702.~ . C/O Check No. "'::2 '-/
Distribution: Clty/Cool"lty - Developer - Accounting - Elementary District