1367 S Lewis St.
~
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-218B
(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 90-day protest period began at the time your project was approved.
Receipt,No: ,"
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Elementary ~
High School District:
Anaheim Union High School District
Owner Information:
Name:
Address:
Phone Number:
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Applicant Information:
Name:
Phone Number: (
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Property Information:
Address of Project:
Oevelopment Type: (
Project Name:
Type:
] Residential - New
Residential - Room Addition
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[ ycommercial
] Single Family
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage: I g-;).. 0
Multiplied by Current Rate: Elem. $ '. i <( = ~"q7. , 0
H.5. $ if( = $&1. , <>
Equals Total Fee: $ . 3'~ - $c,$C. ;;l..O
Residential:
[ ] Level 1 [ ] Level 2 - ACSD Only
Total Square Footage:
Multiplied by Current Rat $
H.S. $
$
CSO Only
=$
=$
=$
Fee Waiver:
Fees Waived:
] Yes
[ 'fJ 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 au atically ter 'nat and the appropriate City/County shall be notified.
Oeveloper/Applicant Signature:
eveloper/Applicant has paid school facility fees in compliance with Government Code
Certification:
This certifies that the above na
Sections 53080 and 65995.
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Oate I
Actual4!Ls ))
Anaheim Union H.S. District
$
$
34 7 66
3;17-66
Check No.
Check No.
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DistrlbutiOfl: City/County - Developer - Accounting # Elementary District