HomeMy WebLinkAbout056-380-004BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
Sci,o61 District c
A.P. Number 00LL— Jurisdiction:. City
Property
Building Department No.
]County
�-�Property Location/Address 7- 1 a Y -\a N
Subdivision Lot No.
....................................... . .................. 4 .....................................
Residential Development Q Q Q Sq. Footage 2(p 3.&
No of Mobile Home Addition/ *Supplemental to (Group R)
Units Installation Conversion Permit #
*(No foundation inspection)
............................................................................................... . ...
Deed Restricted Sq. Footage
(Attach a sioned coDv of Deed Restriction and Notice of Limited Use Facilitv document)
Co m me rc i a 1A rid-uld a I
Now Addition
Building Department Representative
District Identification No. 'k 0 404 0 cif
School District certifies that
(Street Address)
(City)
has complied with the requirements of Resolution No.
0000'" representin
000'-representin . g IQ square feet'. .
School District Representative
Sq. Footage
(including Exterior
Roofed Areas)
Date
JApplicant)
(Phone Number)
(State) (Zip Code)
by payment of $ 7-/-
2926 $
FULL MMGATION
Date
Paid by Check # Remarks:
Mode You may protest the Imposition offfio fen Identiflediii6ove by submitting a written protest tothe District, incompliancewlith
Govenknient Code Section 66020(a), wftWn 90 days from the date less are paid. Failure to submit a timely written protest will'prohitilt
you from challenging the Imposition of do fim In any court action.
K, subsequent to the School District 9ppresontative signing this .Butte County Schools Impact Fee Certification Form, the School Dish In
o"I'l 'by the applicable Local Planning Agency that this pnoct Is being revlewed under the California EnvlmwmnW Quailly Act (M"h
this p ol 1 r - may be suloct to additional school fen to fully midgets. Its Impact on the school districtle schoob.
White (applicant), Yellow (building department), Pink (school district) feeform.xis (10/03)dm.m