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` BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District �� Building Department No.
A.P. Number l V /yU -0-11 Jurisdiction: City rX-1 County
Property Owner
Property Location/Address
Subdivison
Residential Development
No. of Living MHI
Units
Commercial/Industrial
Building Department Representative
0
New
Lot No.
0
Addition
Sq. Footage 5� j
(Group R)
Sq. Footage
Addition
(Floor Plans reviewed by School District Personnel)
.(Including Exterior
Roofed Areas)
►- a -)-g74-
Date
District Identification No.
Lam.-l�/J y School District certifies that
(Applicant)
(Street Address) / (Phone Number)
(City) (State) / (Zip Code) n,
has complied with the requirements of Resolution No. �- �� by payment of $ 7.
r:;presenting �square feet. As 2926 $
School District Representative
PULL MITIGATION $
Date
Paid by Check # Remarks:
Bank Number
Paid by Cash
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 (CEOA), this project may be subject to
additional school fees to fully'Mitigate its impact on the school district's schools.
lr
White (applicant), Yellow (building department), Pink (school district) feeform.wkl (11/94)dmm
O.B.- I
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Attention Property Owner.
An "owner -builder" building permit has been applied for in your name and bearing your
signature. .
Please complete and return this information at your ' earliest opportunity to avoid
unnecessary. delay in processing and issuing your building permit No building permit will
be issued until this verification is received
I. I personally plan to -provide the major labor and materials for construction of the
proposed pro erty improvement: YES[ j . NON. -
2. I SAVE[ HP:VE' NQT[ ] signed an aigLen fQr n: bu,'lding Hermit for the
proposed work-
3.
ork3. I have contracted with the following person (firm) to provide the proposed
construction: - - -
NAMM
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
4. I plan to provide portions of this work, but I have hired the following person to
coordinate, supervise, and provide the major work:
NAME:
ADDRESS: CITY:
PHONE: CONTRACTOR'S LICENSE NO.
S. I will provide some of the work but I have contracted (hired) the following persons to
provide'the work indicated:
NAME ,ADDRESS PHONE TYPE OF WORK
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ON S1/7 C�C1L t'% (/rst�il
S�/i�ra� Gar,
A eLA-vC, /
�.NJ P Con fay �v�/•,(�y.-? Co Ga -c � � �i� � ,
SIGNE .
PROPERTY OWNER
SOCIAL SECURITY NUMBER
DATE: l' 3D --2 %
NOTE: This owner -Builder Verification is required by Section 19831 and
19832 of the California Health and Safety Code.
This verification must be completed and returned to our office before
we are permitted to issue the permit.
Apk D /00 - 0-71 k94- )6f-11r'-qA7-
j;ft. -.-:;i County of Butte
DEPARTMENT OF PUBLIC WORKS
695 Oleander Ave., Chico — 343-4211, Ext. 70
7 County CenteeDr., Oroville — 534-4541
Skyway and Elliott Rd., Paradise — 877-3435
CORRECTION NOTICE
,;.7,,4 .� - 3T3-Tf .....
.................. ; . . . ..................................................................
5 ?i,;i./g or Property Address
A routine inspection indicates that the following
violations of County Ordinance exist at the above
address and should be corrected. Please notify this
office when correction of work is completed. If you
have any question pertaining to this matter, or need
additional explanation, please contact this office
immediatelv.
..................................... .............. .....
—19115to*- ..............
Date&Z-�/- :�� Inspector
Do Not Remove This Tog
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