1015 S CAMBRIDGE ST, B1
2
4
Anaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454
a3�D�Z�
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:�� Z� Anaheim Union High School District
OWNER INFORMATION:
Name: i > .✓ j, / L� c_ :�
Address:
Phone Number: Home ( ) Cell (?,;) 7 -d t
INFORMATION:
Name:
Phone Number: Home (
cell( ; ,. I :i > : � S
Project Address: ii'l5` 1..;,.� l=.:1.;�.
Development Type: (vG) Residential - N ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family<� ( ) Multi -Family Condos/Apartments # of units:
Project Name: _ ��� Ax�) L�'
VIERCIAL: RESIDENTIAL: j ^
Total Square Footage: - Total Square Footage: (J
!led by Current Rate ,�� Multiplied by Current Rate 2 $•, _ J ��
Elem. _ $ Elem. $
S. 5 =5 H.S. 39 5 4,
Equals Total Fee: 5 =5
Waived: ( ) Yes (�6j No If yes, reason:
above respresentations as to square footage are true, Developer/Applicant agrees that If it Is later determined that such respresentations
not true, Certificate shall automatically terminate andpprgpriate OjYlCgunp shall be notified.
veloper/Applicant Signature:
ITIFICATION:
certifies that the above named Developer/Applicant has paid school facility fees In compliance with Government Code Sections 53080 and
Union High School District
FEES PAID: %sue $ A ,-5�j` Check No. 9 3
Union H.S. Dist. $ S� c✓`� Check No.
Distribution: Developer/Applicant, AUHbU Accounung uepartmcm,uc,„cl,.a� r,-,..,., ..�,^�-••---