HomeMy WebLinkAbout056-310-014BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
School District O (/�./ Building Department No.
A.P. Number 6 �1 v Vl dsdiction: City County
Property Owner
Property Location/Address
Subdivision
Residential Development M Q
No of Living Mobile Home
Units Installation
0
Addition
Vjy A (A
Department Representative
03-z'q�`v
Lot No.
............................................................... a ... _.................................
';. Sq. Footage
Addition/ 'Supplemental to (Group R)
Conversion Permit#
*(No foundation Inspection)
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility documen
Sq. Footage
(Including Exterior
Roofed Areas)
Date
District Identification No. n' 7 a
S School District certifies that /
(Applicant)
85�- 3.05 4 s x a
(Street Address) (Phone Number)
(City)
has complied with the requirements of Resolution No.
representing
-'�� O square feet.
School District Representative
Paid by Check #r Remarks:
(State) (Zip Code)
�( hwry f
0 5y' loc by payment of $
2926 $
FULL MRIGATION $
///�y 3
Date
IYo#Ice: You matt protest the Imposition of the lass Identified above by submitting a written protest to the District, In compliance with
Goverment Code Section 66020(a), within 00 days from the data lees are paid. Fallurs to submit a timely written protest wilfprohlbit
you from dnlMnpl. the Imposition of the tees In any court action
K, subsequent to the School District Rep mritatlw signing this Butte County Schools Impact Fee CeMNcatlon Form, the School District Is
rwd&W by the applicable Local Planning Agency that this protect ls beteg rwlew under the California Environmental Quality Act (CEQA)
this pr al a may be sub)ect to additional school fees to fully mltlpate.Ils Impact on the school dlstriati schools.
White (applicant), Yellow (building department), Pink (school district) feeform.xts (10/03)dmm
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S NOTES:
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1. System to be installed per N.F.P.A 13D, manufacturers specifications,
and local A.H.J.
2. All piping to be "Listed" CPVC or equiv.
3. Pipe hangers to be "T41co" or equiv.
4. Freeze protection, water supply, caq)tntry and electrical by others.
S. Riser to be installed in "s!udAray_" within- wAll.
6. Exact pipe run lengths and head locations subject to field verification.
7. Heads to be Reliable Fl/RES/49, K=4.9. Flows based on a -
14'X14' grid pattern. (see attached calcs.)
S. All pipes to be 1 inch diameter unless otherwise noted.
9. Minimum flow and pressure required at BOR: -30 PSI @90 GPM. r
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