290 W LINCOLN AVE (6)Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-350
(714)999-5454
i3�n2oz�l-01$52
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICES: (1) 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 bythe 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 (A
returned check (NSF) Is subject to a $30.00 administrative fee); (2) you have the right to request an audit of Developer Fees per Gov. Code § 66023; (3) You
have the right to file a written request for mailed notice of the District's Board meeting to review the Developer Fees Annual Report; and (4) The Developer Fees Annual
Report and supporting documents are available at: https://www.auhsd.us/District/Department/14195-Facilities.
RECEIPT NO.:
ELEMENTARY DISTRICT:
HIGH SCHOOL DISTRICT:
I �j� b y
IN � ��
Anaheim Union High School District A ( \
2 OWNER INFORMATION:
Name: ( lL 1)1 NttU I AND
Address: 7 S2 S La Z
Phone Number: Home (%ly J � O% — _ �_ Cell (%/q)
3 APPLICANT INFORMATION:
_
....Name: �1 � �/. � W IV( A! C,
Gi
Phone Number: Homeff ( ) "y DJ ' SR i r7 Cell (71L6
3 PROPERTY INFORMATION:
Project Address: C
Development Type: ( ) Residential -New ( ) Room Addition (/y) Commercial:
( ) Single Family Multi -Family Condos/Apartments # of units:
Project Name: C — +f1
COMMERCIAL:
RESIDENTIAL:
Total Square Footage: O"""C7
Total Square Footage:
Multipiled by Current Rate
Elem. ��� "
Multipiled by Current Rate
$ _$ /
Elem.$ _$
H.S. $ •HZ.=$'V�2•G0
Equals Total Fee: $ _ $
Equals Tot = $
FEE WAIVER:
Fees Waived: ( ) Yes ') No If yes, reason:
ACKNOWLEDGEMENTS;
The above respresentations as to square foo age ar true, Develper/Applicant agrees that if it is later determined that such
respresentations are not true, Certificate shal omatically terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:
CERTIFICATION:
This certifies that the above named Develper as paid school facility fees in compliane with Government Code Sections
53080 and 65995. /
III,�-_G7
Date IL resents 've -Anaheim Union High School District
ACTUAL FEES PAID:
A F S D $ Al;z 410 Check No. Low S?D
Anaheim Union H.S. Dist. $ 'yam. C-0 Check No. �D�`7 9