1239 E. Santa Ana St.
~
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714) 999-2188
(714) 520-5741 FAX
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE: The gO-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 gO-day protest period began at the time your project was approved.
Rece~ 11~ Elementarv4-S;;:~ b _
High School District:
Anaheim Union High School District
Name:
Address:
Phone Number:
l'UP
( )
~ ~ ~()t'-><'1./.. '" - ..... ;It.'--..''-.01''-"_.
/:? tLi ~ 0;~.c-i..~~'CJ_
...... - -. '-..-,'. "'~"'< .; ,~
Owner Information:
Applicant Information:
Name;
'Q'~
~
~
Phone Number: ( )
-
Property Information:
Address of Project:
Development Type: [J Residential - New
Project Name:
Type: [YJ Single Famiiy
Commercial:
Total Square Footage:
Multiplied by Current Rate: Elem. $
H.S. $
0~~
[ ~ Residential - Room Addition
~)
[ J Commercial
[ ] MUlti-Family Condos/Apartments - # of units:
Equals Total Fee:
$
-$
=$
=$
Residential:
[ J level 1 [ J level 2 - ACSO Only [ ~ ~<;vel 3- ACSD Only
Total Square Footage: -')('"1 f"
Multiplied by Current Rate: Elem. $ /.1 V_ $ ~3. '12..-
H.S. $ ~ = $ 113.'7v
Equals Total Fee: $ ,;(av = $/'1;[7, '?)
Fee Waiver:
Fees Waived: [ ] Yes
[~ No
If yes, reason:
Acknowledgement:
The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined that such
representations are not true, ce~ificat":J):ma~IIY terminate and the appropriate City/County shall be notified.
Developer/Applicant Signatur~
Certification:
This certifies that the above named Developer/Applicant has paid schooi facility fees in compliance with Government Code
Secti~;~a;5995. ~ ~~
Date 7 7 Representative _ An~ Union High School District
ActU~j).
Anaheim Union H.S. District
$
$
Cj18. '1 d----
,/,/3 .9 ~
Check No.
Check No.
.;:i-,;(g
Sa7
DistributIon: CitY/County - Developer - Accounting . Elemental)' District