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� BUTTE. COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM h
(One form per Building)
School District ( / Building Department No.
A.P. Number urisdiction: City County
Property Owner
Property Location/Address
Subdivision�/ Lot N4 IN'o. �42.
.................................................................. /
Residential Development 4 Sq. Footage �
(py
No of Living Mobile Home Addition/ •Supplemental to (Group R)
Units Installation Conversion Permit #
*(No foundation inspection):
Commercial/Industrial
New, Addition
Irioor rians reviewea ov bcnooi uistnct rersonnei
District Identification No. (} j
School District certifies that
(Street
(City);
has complied with the requirements of Resolution No.
representing /„� square feet.
School District Representative
Paid by Check # Remarks:
Sq. Footage
(Including Exterior
Roofed Areas)
Date
(Applicant)
Number)
(Zip
7 � 7 06 by payment of $ —0
AB 2926 $
FULL MITIGATION $ ll
Date v
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 66020(a), within 90 days from.the date fees are paid. Failure to submit a timely written protest, will prohibit
you from challenging the imposition of the fees in any court action.
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 Califomia Environmental Quality Act ICEQA),
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) feeform.xls (10/98)dmm
BUTTE COUNTY PARKS DEVEWPHENT FEE CERTIFICATION FORM
CHICO ARBA RECREATION AND PARK DISTRICT
Assessor Parcel Number(s) 6q - '�l L,1•
Property Owner_K.A�C�Jx i L
Project Location/Address L + %
Subdivision A b tiJ in V1 1% � K _ Lit Number(s)_
Residential Development: (check one)
New Development _Alteration/Addition _Mobilehome(s) _Non-Residentia.
to Residential
Total Number of Dwelling Units 6
Comment: '
Building Depart nt Representative Date
Chico Area Recreation and Park District(CARD) certifies that
licant Name)
�Cy - A
Street Address
(City)
State
Phone Number
Zip Code
has complied with the requirements of Butte Co. Resolution No. 90-140 by
payment for dwelling units @ $1,189 for total payment of $ ' nC�
� K- I EVIS '
CARD Representative
PAID BY CHECK NO. � REMARKS:
BANK N0. QO•- Z V_
PAID BY CASH
RECEIPT NO.
Distribution: White --Applicant
Pink --CARD
park.fec (form revised 11/90)
-S -01
Date
Yellow --Butte Co.i��ing De
Q�`�ol��odty o i co Buil ng ept.
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