1237 W LASTER AVE, B & CC
3
5
21
8
a
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
$ L D 2022
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
oH1611-1I
OL�-1°)5-
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 $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
Anaheim Union High School District
b_ WNER INFORMATION:
Name:_0duNA UO
Address: Q-51 W Lru4« n,,) , A\Gheim I A go k( ,9_
Phone Number: Home (1ILI) SZ I — 5'._(O9$ Cell ( )
�;LICANT INFORMATION:
Name: --[1` 06A OC
Phone Number: Horne (31Li) 3 O1 9l ti P Cell ( I
_ROPERTY INFORMATION:
Project Address: �"`^�_ 0.4=. gkzx> --p B�
Development Type: ( ) Residential -New ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments H of units:
Project Name: A�«
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage: 3SS
MuRipiled by Current Rate
Multiplied by Current Rate ,s �3
-4,;?L ��
em. $ _ $
Elem. $
H.S. $ =$
H.S.
JEXqualstal$ _ $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes ( No If yes, reason:
CKNOWLEDGEME :
e above respresentations as to square footage are true, Developer/Applicant agrees that if it is later determined that such respresentations
re not true, Certificate shall automatically terminate and 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 53080 and
65995.
Date Repre ntative Anaheim Union High School District
A AL FEES PAID:
�` $ 3, �y�•� 3 Check No. I A3 (n
Anaheim Union H.S. Dist. $ —3 _ eZ Y � 3 Check No. 1 vi1
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department