HomeMy WebLinkAbout030-500-020'.
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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
n �7. (One form per Building)
' :7 v
School District D?z' ✓(� Building Department No.
A.P. Number 030" 5-0OJurisdiction: City County
Property Owner
Property Location/Address
Subdivision
I -
Lot No.
/ 01- U 3-7
Df in
Residential Development
l—J
Q Q ':
Sq. Footage I
No of Living
Mobile Home
Addition/ 'Supplemental to
(Group R)
Units
Installation
Conversion Permit #
F
...............
*(No foundation inspection)
_....................................................................................
Commercial/Industrial Q Q
New n Additlor
Department
District Identification No. '05 01
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Sq. Footage
(Including Exterior
Roofed Areas)
Date
('()P -o Vi I Le... UJ1 1' is'1 (--1 C4 --School District certifies that I I CIAL,Q�Jz--
(� (Applicant)
t0 ` q X80
(Street Address) (Phone Number)
Ib
(City)
has complied with the requirements of Resolution No.
representing ) 0 square feet.
NO
School District Representative
Paid by Check # Remarks:
9S9lpv -
(State) (Zip Code)
I os ' '/ o by payment of $ o� �S� • 3
JAB 2926 $
FULL MrIGATION $
0�.• Date
YouNotla: You may protest the Imposition of the fess Idandfied above by submitting a written protest to the District, In compliance with
.Government Cods Section 66020(a), within 90 days from the date hes are paid. Failure to submit a timely written protest wlll'prohlbit
you from challenging the Impostibn of the fess in any court action.
K, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
rest R by the applicable Local Planning Agency that this project Is being rev' - under the California Environmental Quality Act (CEQAI
this pnoIs, may be subject to sddftlonal school fess to full mitigate. its Impact on the school dMbkft schools.
White (applicant), Yellow (building department), Pink (school district) feeform.xis (10/03)dmm