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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
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 $30.00 administrative fee.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
Anaheim Union High School District /Y
OWNER INFORMATION:
Name: U
Address:_ G) Ln 1pn pL 'lofN C1 m CA q/A o4
Phone Number: Home (7/�) .360 % 1/ c Cell (7/� .360 U/,(�
PPLICANT INFORMATION:
Name:
Phone Number: Home (7/Y) kc) Z.((.r Cell (7 )
PROPERTY INFORMATION:
Project Address)o Zff f 0 Gri Lia,., 0L ,os- j )a6m c.19 740 �,
/ Development Type: ( ) Residential -New ( ) Re d ntial - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: �j>, C=2@yF_
COMMERCIAL:
RESIDENTIAL:
Total Square Footage:
Total Square Footage: 40 Al y
Multipiled by Current Rate
Multipiled by Current Rate
Elam =$
,�/�
Elem.$�'� / _$
.S. $ =$
H.S.�IJr'--$
Equals Tot e: $ _ $
Equals Total Fee: $ _ $
EE WAIVER:
Fees Waived: ( ) Yes No If yes, reason: -
ACKNOWLEDGEMENT:
e above respresentations as to square footage are true, Developer/Applicant agrees that if it is later determined that such respresentations
e not true, Certificate shall automatically terminate and the p priate City/Co my 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.
oZ
Date Rep ative - Anaheim Union High School District
ACTUAL FEES PAID:
�06� ,� � $ Check No.
Anaheim Um n15 H.S. Dist. $ �� �- 'yam?. g' Check No. (r 11- //_iZ
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department