2785,2791,2795 W. Madison Cir.
~
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92C03-3520
(714)' 999-2188 .
(714) 520-5741 FAX . ....
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.
Address:
Phone Number:
High School District:
Anaheim Union High School District
'Owne'r Information:
Name:
o
L--__J__._.._~_._.__.___...__.________.~~..---~.-.
Applicant Information:
Name:
Phone Number: (
Property Information:
Address of Project:
Development Type:
Project Name:
Type:
-)It; ."
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L..:or.O""- ......0(. J -.-:....'0<.'71'''''''...... ,.;:... "'-([&7U5~-_ "_..
[1J Residential.. New
Residential - Room Addition
] Commercial
J Single Family
Multi-Family Condos/Apartments - # of units:
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.5. $
Equals Total Fee: $
=$
=$
$
Residential:
[ ] Level 1 [ J Level 2 .. ACSD Ooly [ J Level 3- ACSD Doly
Total Square Footage: 7/ o~
Multiplied by Current Rate: Elem. $ f,/:2-= $,/0<./1.,).
H.S. $ ./':2/ = $'tc>V7. ;;l.
Equals Total Fee: $ ,)',,;(! vc./t)'lt!. i:?
Fee Waiver:
Fees Waived:
Yes
[ VI 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 auto ally termi nd 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 53 80 and 65995.
>'
Date
s Paid: ~~
$
$
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~t)(/ ..;t()
Check No.
Check No.
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Distribution: City/County - Develooer - Accountlna - ElementiHv Ollitrlct