3156 W. Polk Ave.
~ Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
~. , (714) 999-2188
~II (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:
J( ~Lj '6
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High School District:
Anaheim Union High School District
Owner Information:
Name:
Address:
Phone Number:
Applicant Information:
Name:
Phone Number: (
~~~
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Property Information:
Address of Project:
Development Type:
Project Name:
Type:
1 ReSidential - New
~~~~~
['Xl Residential - Room Addition [ Commercial
1 Singie Family
Multi-Family Condos/Apartments - # of units:
Commercial:
Residential:
$
=$
=$
-$
[ 1 Level 1 [ 1 Levei 2 - ACSD Only [ 1 Level 3- ACSD Only
Total Square Footage: I ~'? t, 0
Multiplied by Current Rate: Elem. $' ~ /''2-= $/ .s,.-;{3.
H.S. $ ./'2-- = $/ ~-23. .
$ <>f .P..0 = ~Y~-Yc
Equals Total Fee:
Total Square Footage:
Multiplied by Current Rate:
$
Fee Waiver:
Fees Waived:
Yes
[,Xl 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 automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
Certification:
This certifies that the above named Developerl Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995.
7-<?-OS-
J}w
Date
Union High School District
Act(1 Fees Paid~
~~,V
$
$
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1~~3.2D
Check No.
Check No.
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/'8-11
Anaheim Union H.S. District
Distribution: CitY/CountY. Developer - Accounting . Elementary District