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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form. per Building)
School District t Building Department No.
A.P. NumberJurisdiction: �� City ®County
Property Owner
Property Location/Ac
Subdivision
...............................................................................................
Residential Development s Sq. Footage 50
No of Living Mobile Home Addition/ 'Supplemental to (Group R)
Units Installation Conversion Permit #
'(No foundation inspection):
..................................................................................................................
y
Commercial/Industrial 0
New Addition
Building Department Representative
moor rians reviewed ov scnooi uistnct versonnel
District Identification No. 3
School District certifies that
Sq. Footage
(including Exterior
Roofed Areas)
/- /x-03
Date
(Applicant)
(Street Address) U a (Phone Number)
(City) (State) (Zip Code) T
2
�3� . /
has complied with the requirements of Resolution No. � "' Eby payment of $
representing o� J� square feet.
School
Paid by Check # Remarks:
AB 2926 $
FULL MITIGATION $
//-7 A�
Date
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 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) feeform.xis (10/98)dmm
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BUTTE COUNTY PARRS DEVELOPMENT FSE CERTIFICATION FORM
CHICO AREA REC//RE��ATION AND
tt PARR D//I''S��T/R'IICT
Assessor Parcel 'Number (.$) . "�•t `'I C,J L ,!
Property Owner
4
Project Location/Address
Subdivision Lot Nlm r (s
Residential Development: (check one),
New Development _Alteration/Addition _Mobilehome(s) _Non -Residential
I to Residential
Total Number of Dwelling Units `
Comment:
Building Department Representative Date
�r�Ar�M�KYtytikyt�kYlr�ktt�rYr�k•kYt�kyrytYr�krtyrY�r�kYr�k�rvr�kMr�k�kik�k�kyt�r�k�kYr�kY�rvrx•�k�kik�kYeyr.Yr•kilo•�kYrYlrYr�k�k�r�k�ArUnAnkytMnk�rytUr
Chico Area Recreation and Park District(CARD) certifies that
(Applicant Name) (Phone Number)
7V SeA
(Street ddress) ,
(City) r tate) (Zip Code)
has complied"with the requirements of*Butte Co. Resolution.Nb. 90-140 by
payment for _ dwelling units @ $1,189 for total payment of $ �„�k-
1112&3
-112 &3
CARD'Representative Date
PAID BY CHECK NO. . (% REMARKS: w
BANK NO.
PAID BY CASH
RECEIPT NO.
Distribution: White --Applicant
Pink --CARD
park.fec (form revised 11/90)
Yellow --Butte Co. Building Dept.
Goldenrod' --City of Chico Building. Dept.
011/17/0 #0949 1:54PM XXXTOTAL $1189A
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