HomeMy WebLinkAbout066-030-031BUTTE COUNTY SCHOOLS QEVELQPMENT FEE CERTIFICATION FORM
(One Form per Building)
A.P. Number ,,/ 3 Building ,Depaf tment NO.
School -District Fa Y-0. a( S,9 City County1� Jurisdiction
Property Owner S t Y' Q t,,, SC
Project Location/Address �.�L'i
Subdivision Lot Number
Residential Development:
a Sq. Footage
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: a Sq. Footage
New Addition (Including Exterior
Roofed Areas)
Building Department Representative Date
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(Floor Plans reviewed by School District Personnel)
District Id No.
School District certifies that
(Applicant Name) (Phone Number)
ozo'-V ai41
.,-(NStreet Address)
State
Zip Code)
has complied with the.re//quirements of Resolution No.
by,the payment of $ ary representing square feet.
School District Representative Date
PAID BY CHECK NO.
BANK NO_ 9d -'�T
PAID BY CASH
REMARKS:
r, white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)
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