1828 W GLEN AVE, 71
2
4
5
1.1
7
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-5454 2Yl ,1
?j L� 2D 2 I C) '",J -" I "
CERTIFICATE of COMPLIANCE
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:
0 g
A S1
Anaheim Union High School
-OWNER INFORMATION:
Name: I D) 51 Dt1 t'EC�
c D' p �n
Address: I�NZ� i�ri�u�SlAve- . .E�,r�"'j S OOy 3
Phone Number: Home ( ) Cell ( )
A4TLICANT INFORMATION: p' Q
Name: ���1(.� '`w('7JlV l• �
Phone Number: Hornei ( ) Cell (5bZI Sy 9 91
PROPERTY INFORMATION:
`
Project Address: 1
Development Type: ( Residential - New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: C"y..�
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage:
Muitipiled by Current Rate
_ $
Multipiled by Current Rate
Elem. $3r S.
H.S. $ = $
�9.��
H.S. ;• S I. D 9 O_�
Equals al Fee: $ = $
Equals Total Fee: $ _ $
FEE WAIVER:
Fees Waived: ( ) Yes ) No If yes, reason: -
OWILEDGEMENT:
i
The ab 've respresentations as to square footage are true, Developer/Applicant agrees that if it is later determined that such respresentations
are of true, Certificate shall automatically terminate and th pro riate 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 Re esent 've - Anaheim Union High School District
ACTUAL FEES PAID: /
2�S $ /' �9a, oS Check No.
Anaheim Union H.S. Dist. $ /, R- 9,2• D '75- Check No. / / 0 r0
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department