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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District C b '� Building Department No.
,. A.P. Number �I ,� I I)L) ^ (>_ /) Qe Jurisdiction: 0 City [ County
Property Owner
Property Locatic
Subdivison N Lot No.
Residential Development
No. of Living MHI Addition
Units
Commercial/Industrial
New Addition
Building Department Representative
(Floor Plans reviewed by School District Personnel)
District Identification No. Q 01-11
�,h i p 'n LQ T I ,A' -i School District certifies that
Sq. Footage ?4--79
( roup R
0_
Sq. Footage
(Including Exterior
Roofed Areas)
Date
OA K. UAL,
�'✓' (Applicant) '
(Street Address) — (Phone Number)
C145M -1 5�
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. -p 4— by payment of $ 1-5
representing " �/z, square feet. AB 2926 $
FULL MITIGATION $
Schon istrict Representative Date
a
Paid by Check #
Bank Number
Paid by Cash
1/ 10UNK` I /
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee
Certification Form, the School District is notified by the applicable Local Planning Agency that this project
is being reviewed under the California Environmental Quality Act (CEQA), this project may be subject to
additional school fees .to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink (school district) feetormmkt (11/94)dmm
RM�
A & QI-ENGINEERING
Civil Engineers
(D
1280 E. 9th Street
JUN
Suite C
Chico, CA 95928
Building Official
County of Butte
7 County Center Drive
Oroville, CA 95-965