707 S. Walnut Anaheim
.f-~
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
NOTICE: The gO-day period in which you may protest the fee described herein will begin on the date this fee is
paid. However, !fthe fee was imposed by the City or Couhty as a condition of approval for your project, and you
have received the requisite notice, the gO-day protest period 'lepn at the time your project was approved.
R7;:;/ry Elementary District: High School District: .
Ik-~}) . ~ Anaheim Union High School District
,
Owner Information: qj;je~/LlW~
Name: ~.
Address:
-Phone Number: ( ) - --" -. --"---..--- -
-
Applicant Information: ~ ~.
Name: ~
Phone Number: ( )
Property Information: ~~~
Address of Project:
Dev~lopment Type: [ ] Residential - New [YJ Residential- Room Addition [ ; J Commercial
Proj4ct Name: ,
Type: [ J Single Family [ ] Multi-Family Condos/Apartments - # of units:
Commercial: Residential:
Total Square Footage: [ J level 1 [ ] Level 2 - ACSD Only [ ] Level 3- ACSD Only
Multiplied by Current Rate: Elem. $ ~$ Total Square Footage: ~?<
H.S. $ ~$ Multipiied by Current Rate: Eiem. $ I. I 2- $ IjGO.cJV
Equals Total Fee: $ ~$ H.S. $ /;;-- - $ J;::
Equals Total Fee: $ ~.;Z ~ $ , t?
Fee Waiver: [Y No
Fees Waived: [ J Yes If yes, reason:
'.' ,:..,,-~. ~,",...., ~'k" . ,-:- , ..
Acknowledgement: ,-
The above repres.entations as to square footage are true. Oeveloper/ 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.
Deveioper/Applicant Signature.:r A IW"~ J/~
Certificatiom i .
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code
Sections 53080 and 65995. Representative~~igh s~
! ~ ;;( (-Or,;-
Date
A.ctums4~ $ Ai 00, ,.-0 Check No. (/.fi.. .A -' J:r
Anaheim Union H.S. District $ 7tJO .C'1) Check No. nd vf../ ./ .JJf
Di!':tribution: City/County - DeveloDer - Accollntino - Elementarv District