HomeMy WebLinkAbout064-390-009BUTTE (COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
11; (One -Form' per Building)
A.P . Number,»j "'�9-D 9 Building Department No.
School District City n County L Jurisdiction
Property Owner s ho V1 �/�%r-
Project Location/Address �Q (/' j �"j ►� U)a V Ina a
r `
Subdivision (h �'� Lot Number
Residential Development:�
Sq. Footage
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: a a Sq. Footage
New Addition (Including Exterior
Roofed Areas)
Biitiild:ng Department Representative `Date"
(Floor Plans reviewed by School District Personnel)
District Id No.
0,4A*J ,t T Q School District certifies that
no .iA I cit A
(Ap'plicant Name)/'I (Phone Number)
Street Address
(`City) (State) (Zip Code)
� 4
has complied with the requirements of Resolution No.
by the payment of $ �j`,lp(� representing �`j%� square feet.
QA 4 ;Wr 6 -� /A/ii/Z<7
Scho`ol_Distr ct Representative 'Date '
PAID BY CHECK NO. /& REMARKS:
BANK NO X 'a
PAID BY CASH
R
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
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