1743 S GARDEN DR, #BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
UNLIMITED RECEIVED
«
BUILDING DIVISION
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.Returned checks {NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
^Anaheim Union High School District1
OWNER INFORMATION:
C)JUD(T -Ho ^,\yr -AY\cMt>AW
cn4-'¥iS -9^1/
Name:
Address:2
Phone Number:Home (Cell
APPLICANT INFORMATION:
Query M ftpName:3
(7/4 496.-OTPhoneNumber:Home(Cell
PROPERTY INFORMATION:
Project Address:
Development Type:()Residential -Ne^^{}Residential -Room Addition
{)Single Family
4 {}Commercial:
()Multi-Family Condos/Apartments #of units:
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
RESIDENTIAL:^99TotalSquareFootage:
Multiplied by Current Rate
5 Elem.$_Elem.S
=$H.S.
Equals ToULFe^T$=S Equals Total Fee:$=$
FEE WAIVER:
6 MFeesWaived:{)Yes No If yes,reason:
A(^(90WtE[>gEMENT:t
The above respresentations as to square footage are true,Developer/Applicant agrees that if It is later determined that such respresentations
4e C)tv/Countv shall be notified.7 are not true,Certificate shall automatically terminate and the app 7Developer/Applicant Signature:L
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
\
Represehtativ^-Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
IDS.$Check No.
Check No.(Ot)9
$Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department