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- BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Forth Per Building)
School District Pmhovi-c a", P/ cp S-, /-4. / Building Department No.
A.P. Number f�— .'� O.iZ Jurisdiction
Property Owner
Property Location/Address
0 City [��County
Subdivison ?//� /jt'!�-L:T Lot No.
Residential Development M 0
No. of Living MHI Addition
Units
Commercial/Industrial Lam'
New Addition
(Floor Plans reviewed by School District Personnel)
DOtdclentification No.
School District certifies that
(Street
(City)
has complied with the requirements of Resolution No,
ng square feet.
1
resentative
Paid by Check # //( Remarks:
Bank Number //-
Paid by Cash
4
Sq. Footage 3d
(soup R)
Sq. Footage
(Including Exterior
Roofed Areas)
D e
(Applic
0 7
(Phone Number)
(Zip Code)
by payment of $��/3�
AB 2926 $
FULL MITIGATION $
Date
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 (CEQAA), 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) feeformmkl (11/94)dmm