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-BUTTE COUNTY SC$OOLSIDEVELOPMENT FEE CERTIFICATION FORM~
(One,Form per Building)
A:'P~= Numb er / Building Department No.
School District p(� - • City D County lk Jurisdiction
Property Owner e
Project Location/Address
Subdivision £ Lot Number
Residential Development: J
Sq. Footage o2 q /' /j
..
# of Living MHI Addition (Group.R)
Units
Commercial/Industrial: Sq. Footage
New Addition (Including -Exterior
Roofed Areasj
Building Dep tment' Representatieve
(Moor Plans -reviewed by School District Personnel)
District Id No.
School District certifies that
4(Applicant Na e) I(Phone Number)
� -�---- (Street Address)
. t
'4
( ity) ( State) -(Zip Code.) _
has complied with the requirements of Res'1u=ti�on'140-." ! _ -
.�
by the payment represent .ng.� square feet.
n$ €.. tVy.J e
SchodlDistrict JQ0res ntative,,� ,. Date
PAID BY CHECK NO.- REMARKS: 6 { ' `
BANK NO
ro °k
PAID BY CASH
white -applicant, yellow-buildin4.4department, pink -school district
SCHOOL.FEE (8/88) j+