1248 Lighthouse Ln.
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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 FAA
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.
Receipt No:
.s-3/
OWner Information:
Name:
Address:
Phone Number:
Applicant Information:
Name:
Phone Number: (
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
Elementary District:
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High School District:
Anaheim Union High School District
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] Residential - Ne'w []
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Residential - Room ddltlOn [] Commercial
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] Singie Family [I]
2..
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Squa.re Footage:
Multiplied by Current Rate: Elem. $
H.5. $
EqualS Total Fee:
Fee Waiver:
Fees Waived: _ [ ] Yes
Developer/Applicant Signature:
$
=$
=$
-$
Residential:
[ ] Level 1 [ ] level 2 - ACSO Only [ ] level 3- ACSO Only
Total Square Footage: d'1lJ;;'-
Multiplied by Current Rate: Elem. $ f IV = ;3;/ t 1.
H.S. $ ./'2/ = $3;;1'7.
Equais Total Fee: $ j;( . <iL<I - d~ ~y(
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[
,-
No
If yes, reason:
Certification:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
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Date I /
ActualWi~.
Anaheim Union H.S. District
$
$
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Check No.
Check No.
Distribution: City/Count)' - Developer - AccountIng ~ Elementary District