613 S. Verona St.
.~
Anaheim Union Hi'gh School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-2188
(714) 520-5741 FAX
...,,,,.....
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 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.
Receipt No:
.,J}/-':59
Elementary District:
Ma \({)\;~ ~\J);d-r'lct
UtA!'... ~lA..-\
(ol~ S. Ver;D""" ~
')ILl .l <:Y7 r 19; '7 D;
High School District:
Anaheim Union High School District
Owner Information:
Name:
Address:
Phone Number:
'. 4\.-nfl,he; fVI
Applicant Information:
Name:
Phone Number: (
.::aM. ~
Property Information:
Address of Project:
Deveiopment Type:
Project Name:
Type:
[
&13 S. Ve-ronq St.,) iLhahf~tv1
] Residential - New [ vrResidentlal - Room Addition
'-"
] Commercial
[v0ingie Family
MUlti-Family Condos/Apartments - # of units:
Commercial:
Residential:
Total Square Footage:
Multiplied by Current Rate:
$
- $
=$
=$
[ ] Level 1 [ ] Level 2 - ACSD Only [ ] Level 3- ACSD Only
Total Square Footage: {/7 9
Multiplied by Current Rate: Elem. $ /./d
H.S. $ /. 1:2.
$ ..2 . .)<-{
EqualS Total Fee:
- $ '71u.1 .'-18
= $ ')&0 !-n
= $15:;.o.'7u
Equals Total $
fee Waiver:
Fees Waived:
Yes
[ l-(NO
If yes, reason:
Acknowledgement:
The above representations as to square foota
representations are not true, Certificate sh I au
Developer/Applicant Signature:
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
~J(;(t.L/OS"
I -'-j
Date
Actual Fees {'aid:
JY\cmno \\~
AnaheirtrJUnron H.S. Dlstnct
\.1jMC ~
. F
Representative - Anaheim Unio High School District
$ f] (pC) LIR
$ '/100.4 K
Check No.
Check No.
/tf16
fn91
Distribution: City/County. Developer - Accounting . Elementary District