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Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE ` 02C523-L)Aa l
PAYMENT of SCHOOL FACILITY FEES
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 $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
�a *;75
`
1 DAAnaheim
Union High School District
OWNER INFORMATION:
Name: b 4.
Address:
i
Phone Number: Home (r6(A) Cell (t)(Lj,
APPLICANT INFORMATION:
Name: S'\I✓l T� ���/ '1
Phone Number: Home ( ) Cell ( )
PROPERTY INFORMATION:
Project Address:
Development Type: ( ) Residential - New esidential - Room Addition ( ) Commercial:
( ) Single Family ! ( ) Multi -Family Condos/Apartments If of units:
Project Name:
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage: 43 d
Multiplied by Current Rate
Elem.$
Muhipiled by Current Rate
"01_y1=$ 9> I>
_$
Elem.$
$ _$
H.S. $a3g $ i, 343. �L%
Equals T ee: $ = 5
Equals Total Fee: $ = $
FEE WAIVER:
Fees Waived:( ) Yes ( zNo If yes, reason:
ACKNOWLEDGEMENT:
The above respresentations as to square footage are true, Developer/Applicant a ees that if it is later determined that such resprese Cations
are not true, Certificate shall automatically ter 'n�e appropriate City/County s II 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 Represent - heim Union High School District
ACTUAL FEES P D: s t - $ ^
—�ls�$ �� >0
r Check No.
Anaheim Union H.S. Dist.
����/,, Check No. 41 1
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department