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`s BUTTE COUNTY SCHOOL'S ?DEVELOn`MENTR,.FEE CERTIFIC'AT,I.ON FORM
(One Form Per,Building)'
A. P. Number -1?-,i C -� � q)-9,, '. Building Depa(r• tment No.
School•District. 1 O. NI��E D City County x J:urisdretion
C O
Property Ownerti
t o � ,. b ,,
Project Location/Address 6, Ai 1,MI
.•v
A X
Subdivision ;Lot.Number '
Residential Development:
.a Sq:. Footage
# of Living MH�I r A'ddi t�'oi (Group. R )
`, r a,-�
Units
Commercial/Industrial:A`� �„ S'q: `Footage
1Nfew�� A�'ddti`fdh: ( Inc1udi.ng Exterior
3. ti
`:Roofed Areas)
B.0 i 1 d i n 4 Dep�alrtin'ent .R"epr'e's�ent!at�i e= f °' Da'te'
Plans 'reviewed by wS'cfhool District Personnel)rs
P, • r,
`District` Id .,No ,':.R96" 3.?
?�CoU,ur/E
School District certifies tYiat,
r v _CApP'riCant Name) '(� . ('Phone Number)
(Street Address)
(City) -('State).' ('Zip Code )
has complied_ with the requirements of Resolution No.
by!the.payment of $ CPO representing. 300Y s ware feet.
Schodl/.Disteict(Repres-entative
PAID BY CHECK NO. REMARKS:
BANK NO
PAID BY CASH
white -applicant, yellow department, pink -school district
SCHOOL.FEE (8/88)'
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