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BUTTE COUNTY PARRS DSVEWPHSHT FBS CERTIFICATION FORK[
CHICO AREA RECRSATION)0.,. PARP. DISTRICT
-011
Assessor Parcel Number(s) �/!1 �3� ✓
Property Owner Me d r _v, 0
Project Location/Address �,f tial hemi
Subdivision Lot Number(s)
Residential Development: (check one)
New Development _Alteration/Addition _Mobilehome(s) Non -Residential'
to
to Residential
Total Number of Dwelling Units
Comment:
nt Representative
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Chico Area Recreation and Park District(CARD) certifies that
V./
Sad 3 -1S -S'2
(Applicant Name) (Phone Number) .
za
(Street Address)
Ck
(City) (State) (Zip Code)
has complied with the requirements of Butte Co. Resolution No. 90-1400 by
payment for dwelling units @ $1,189 for total payment of $
CARD Representative Date `
Y
PAID BY CHECK NO. ` REMARKS:
BANK NO. _
PAID BY CASH
RECEIPT NO.
Distribution: White --Applicant
Pink --CARD
park.fec (form revised 11/90)
)
�r
09/11/02 #}201 8:44AM XXXTUTAL $1189.00.
Yellow --Butte Co.. Building Dept.
Goldenrod --City 'of Chico Building Dept.
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Bullding)
School District �� ✓-f-� + ° Building Dep ment No.
A.P. Number 4/Z-�D Jurisdiction` City ounty
Property Owner 4 a. no
Property Location/Address
Subdivision Lot No.
................................................................................;
Residential Development Sq. Footage 3
No o Living Mobile Home Addition/ 'Supplemental to (Group R)
Units Installation Conversion Permit #
'(No foundation inspection):
...................................................................................................................
- Commercial/Industrial -1` -`5 /t * ' 1 t t ' / Sq. Footage
New Addition (Including Exterior
r r Roofed Areas)
Building Department Representative Date
Y
moor roans revieweo oy ocnow uisinci r'ersonnen
District Identification No. Q q g
10115 School District certifies that — /j G,r
(Applicant)
(Street
(City) r
has complied with the requirements of Resolution No.
representing 917 square feet.
A—S.6t
School District Representative
Paid by Check # Remarks:
(Phone Number)
17`� is
(State) (Zip Code)
U(� by payment of $
AB 2926 $
FULL MITIGATION $
Date e
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.As (10/98)dmm
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CHIC® CALIFORNIA
DETERMINE NE APPROXIMATE ELEVATIONATION
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BOOK _PAGE ,
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PRINTS ARE —FREE POOLS
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MAILING ADDRESS—,#9
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Alyssum Way
95928Chico, California
BeIICK,.
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Ph 342-46 39
38 one
Contr. L c # 0826I
N090202
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