1872 S EILEEN DR, BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
CERTIFICATE of COMPLIANCE _bLD20_2� -(Dqq 15
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. Retumed checks (NSF) are subject to a $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
�S (�
Anaheim Union High School District A d
OWNER INFORMATION:
Name: L/ /���f it / 1
Address: / g 72_ .S Elul _ E=_�/ A k A7v4-tt �.,9 Zip/ 9 z d Z
Phone Number: Home ( ) Cell(7 $0 67 ?I —
APPLICANT INFORMATION:
Name: 4% tl /(.(., l p L'
Phone Number: Horne( ) Cell (7/V) 6 L3 —%Oi D
PROPERTY INFORMATION:
Project Address:
Development Type: ( ) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:
RE EN FAIL:
Total Square Footage:
p.
Total Square Footage: �� O
Multiplied by Current Rate
Elem. _$
Multiplied by Current Rate ��77 G�
Elem.$,;2_39�
.s. $ =$
H.S. $a�3q�$ .L,
Equals Tota : $ _ $
Equals Total Fee: $ _ $
EE WAIVER:
Fees Waived:( ) Yes ( No If yes, reason:
ONMERNM
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 a appro 'ate City/Coun all be notified.
Developer/Applicant Signature: dl=-
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Secdons 53080 and
65995.
S i o ;3
Date Repres ive naheim Union High School District
ACTUAL FEES PAID:
_ FS $ �, �" 1 • ev % Check No. ✓ /
Anaheim Union H.S. Dist. $ /, .6 / Check No. /Lo(�
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary school District Accounting Department