HomeMy WebLinkAbout065-350-054• BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District ` CI l Building Department No.
A.P. Number V- 3S- �_CI Jurisdiction _ J City Courity
Property Owner. i'LGI
Property Location/Address _—_ _ e CCl'1 �Q
J
Subdivison Lot No. /
Residential Development14'
Sq. Footage
No. of Living MHI Addition (Group R)
Units
Commercial/Industrial
Building Department
i --I
New
Sq. Footage
Addition
(Floor Plans reviewed by School District Personnel)
District Identification No.
{ ! School District certifies that
(Street Address)
(City)
(State)
has complied with the requirements of Resolution No. __
representing�� _ — square feet.
School D strict Representative
Paid by Check Number � Remalllrks: p
Bank Number
Paid by Cash _ __..__........_.._.
(Including Exterior
Roofed Areas)
.. / 1_2 C) - ? Z
DateV
(Applicant)
. r J
(Phone Number)
(Zip Code)
by payment of $ ✓ J
Date I
-A, subsequent to the School District Representative signing this Butte CountyAchdols 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)
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BUTTE
BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One Form per Building)
A. P. Number, �,.' "rs� Building Department No.
School District /Di4L� City [�:] County Jurisdiction
Property Owner
Project Location/Address
Subdivision
Lot Number
t1
Residential Development:
a � Sq. Footage
# of iving MHI Addition (G oup R)
Units
Commercial/Industrial:/ D Sq. Footage
New Addition (Including Exterior
Roofed Areas) r �.
wilding DepartmervK resentative Bate
(Floor Plans reviewed by School District.Perso:nnel)
Distrix Id No.
r), _ . %I n
Applicant Name)
Street Address)
School District certifies that
Phone Number
E"_ v 0'a-_ - I J 6
( ity) P (State) (Zip Code)
has complied with the require m/e/nts of Resolution No.
by the payment of $ g��j, y- representing square feet.
J�d_, 0
Sc ool District Representative Date`
PAID BY CHECK NO. —
BANK NO r �J
PAID BY CASH
REMARKS:
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)