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BUTTE COUNTY DEVELOPMENT -FEE CERTIFICATION FORM
0 FEA�HER RIVER RECREATION AND PARK DISTRICT (FRRPD)
6'CHICO AREA RECREATION AND PARK DISTRICT (CARD)
❑ PARADISE RECREATION AND PARK DISTRICT (PRPD)
0 DURHAM RECREATION AND PARK DISTRICT (DRPD)
Assessor Parcel Number (s) (")_17 - ?Sn Building Pen -nit Number
Property Owner (s
Project Location /.
Subdivision Name
!/ New Development
Alteration/Addition(s)
Mobile home
Demo Permit (datei s
Comments: f)rp-l� _ U/ J
Assessable Sq. Ftge
Type of Residential Development (check one)
Single Family -Detached Single Family -Attached
Non -Residential to Residential Multi -Family Dwelling
Mobile home replacement verified by Assessor Department
verified by Building Department
Building Department Representative Date
❑ FRRP 0 CARD ❑ PID ❑ DRPD certifies that:
(AJ� S �3q9 tZSc� 62y 3Y�d
Applicant Name Phone Number
Olen Cid 1?SV e/,n
Mailing Address
City
Has complied with requirements of the Butte County Board of Supervisors Resolution No.
by Payment of:
Dwelling Units @ $ per unit for a total of $ 9375..�
Square Feet @ $ per sq foot for a total of $
Remarks:
7b-7,4 15P ID
Paid heck Pai by ash: Receipt No:
01`01/f'16 487T*Iy c�pv��
Recreation and k istric presentative$.i
Zip
R�-
1 BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATIOWFORM
vK (One form per Building)
School District Building Department No.
A.P. Number 19"56'`/yp / Jurisdiction: city County
Property Owner
Property Location
on 361'
Subdivision
Lot No:
Residential Development Q
Q
Q.
Q Sq. Footage 2
No of Living
Mobile Home
Addition/
'Supplemental to (Group. R)
Units
Installation
Conversion
Permit #
........................................................................................
•(No foundation inspection)
Commercial/Industrial. 0 0
/ ,New Addition
Department
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Sq. Footage
Date
(Including Exterior
Roofed Areas)
District Identification No. 06y) 300
ua) School District certifies that
(Applicant)
(Street Address) y (Phone Number)
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. 9da 67�/ by payment of $ f9&95
representing c; 900 square feet. AB 2926 5.
FULL MITIGATION $
School District Representative Date
Paid by Check # (� Remarks:
Nodce: You may protest the Imposition of the fess Identified above by submktinp a written protest to the District, In compllance with
Government Cods Section 66020(a), within 90 days from the date Nes aro paid. Failure to submk 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 Inrpaet on the school district's schools.
White (school district), Yellow (building department), Pink (applicant). feeionn.xls (3I05)dr=