2230 E. Winston Rd.
/
~l?E.D PUBLIC WORKS DEPARTMENT FEES
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o EASTERN TRANSPORTATION CORRIDOR FEE:
101-412-F724-6704
COMMENT:
REVIEWED BY: ALFREDYALDA(714)765-5183 A V DATE: "It
--DEVELOPMENT SERVICES FEES--
RlGHTOFWAY REVIEWED BY DATE:
o OLD ZONING CODE (i.e. in plan check or entitlement prior to July 8, 2004)
o NEW ZONING CODE
DEDICATION
CREDIT
STREET IMPROVEMENTIREPAlR
SEWER CONNECTION FEE
AC,cT #
CITY SEWER ASSESSMENT
ACCT #
DRAINAGE ASSESSMENT FEE
ACCT #
GRADING:
WATER QUALITY MANAGEMENT PLAN (WQMP)
LAND SUBDIVISION:
REVIEWED BY:
Anaheim Union High 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
NonCE: 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 90-day protest period began at the time your project was approved.
Receipt No:
d2&(lp
Elementary District:
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Owner Information:
Name: rtb CDn34:~~ :lm:. ,
Address: -1::2 J 0 ;J lJp.-{4'a~{) n $'1 it... D . )
Phone Number: ('714 ) (;?:,~ - 00(/6 tJ '
High School District:
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Anaheim Union High School District
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Applicant Information:
Name:
Phone Number: (
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
c2:l ~() E,
) Residential - New (
l.R)t(\,~" AJe. JrMaheWl
] Residential - Room Addition ( (.Y6,mmercial
) Single Family
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage: 3 4 .:5 '7
Multiplied by Current Rate: Elem. $ A- = $ lp{1Ud.
H.S. $ ,('it = $ ((,I&.(,,(p
Equals Total fee: $ ...3(" - $/~ <\17.
Residential:
[ ) Level 1 ( ) Level 2 - ACSO Only
Total Square Footage:
Multiplied by Current Rate:
( ]
-$
=$
-$
E
otal fee:
H.S.
$
Fee Waiver:
Fees Waived:
Yes
(~
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 autom cally terminate CJ the appropriate City/County shall be notified.
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.
IO/13/{),;'
Date
,
n High School District
Actual Fees Paid:
_~(l /~ 0
Anaheim Union H.5. District
$
$
(Pl~.&c"
If (I{ . Coy,
Check No.
Check No.
d (((9
4f II d.-O
Distribution: City/County. Developer - Accounting - Elementary District