2136 S DELLA LN, C21-02112)Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
RECEIVED
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
JUL 1 5 2022
CITY OF ANAHEIM
PI ANNINr,«BllliniM<^P-:PT.
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 wasimposedbytheCityorCountyasaconditionofapprovalforyourproject,and you have received the requisite notice,the 90-day protest periodbeganatthetimeyourprojectwasapproved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1A ^.
OWNER INFORMATION:
Name:
Address:Ua A
Phone Number:
2 c/\Q'2So^vr\
CellTi)f4'7 -
APPLICANT INFORMATION:
Name:
Phone Number:Home(
3 CS.
Cell(
PROPERTY INFORMATION:
Project Address:^1 tU AaqUi
Development Type:{)Residential -New {)Residential -Room Addition
()Single Family
4 {)Commercial:
()Multi-Family Condos/Apartments #of units:
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Elem.
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
5 Elem.S
CS.H.S.
Equals TotaLF«^$Equals Total Fee:$=$J
FEE WAIVER:
Fees Waived:{)Yes6 iy No If yes,reason:
ACKNOWLEDGEMENT:'
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
7
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
Ive -Anaheim Union High School DistrictRepressDate
ACTUAL FEES PAID:^
$V ^
A-E $Check No.
Check No.
9
Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department