HomeMy WebLinkAbout064-180-014BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
`. (One Form Per Building)
School. District �9//�S�r% _ —_ _ _ — _ Building Department No.
A.P. Number? 'O Jurisdiction (_� City—County.
II
Property OwnerV�
Property Location/Address
70
L
Subdivison
Lot No.
Residential Development
_
_
C 9
Sq. Footage 1 J / 2
No.o Living
MHi
Addition
(Group R)
Units
Commercial/Industrial
Sq. Footage
1
New
Addition
(Including Exterior
Roofe`�d�Areas)
VAAL�o
Buildi Department Represent
ive
Date
(Floor Plans reviewed by School DistrictPersonnel)
District Identification No
School District certifies that
(Applicant)
(Street Addre$s) (Phone Number)
f 1 A - n n../ 'n . i
(city) ..\1,
has complied,with the requirements of Resolution No. _
representing . I_ __-square feet.
School Distrid"t Representative
Paid by Check Number
Bank Number
Paid by Cash
ate) (Zip Code)\,
by payment of $ g,
I�
Date
Remarks:
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) feeformmkt (4/92)