HomeMy WebLinkAbout068-010-003BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
::- (One form per Building)
School District 1// 7'1,?4 b 1/ Building Department No.
A.P. Number 196fq • 8/0- t�O 3 Jurisdiction: City . OCounty
Property Owner /yJ 0/y) / 4:F'
Property Location/Address 4-00 �, /%c% 5�/r L-/✓ �)dy /lc�
v
Subdivision Lot No.
.....................................................................................
Residential Development Q Q Q Q Sq. Footage (6 8 S r
No of Living Mobile Home Addition/ 'Supplemental to (Group. R)
Units Installation Conversion Permit #
.(No foundation inspection)
. : ...............................7'**-----'*--- ...........................
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document),
Commercial/Industrial Q Sq. Footage
New Addition (Including Exterior
C Roofed Areas)
Bwtdina Deoartment Re resentative . Date
District Identification No. ""] 3 k3
.0,r- o v -A Se w. School District certifies that � . �� M a c
(Applicant)
(Street Address) (Phone Number)
(City) (State) (Zip Code)
3i
has complied with the requirements of Resolution No. C3 -d `E _14 by payment of $
representing (o le 8 square feet. BLL S
ULL MITIGATION :
FV
School District
Paid by Check # Remarks: 0 1e — 0
1 b b ,P't? �. • � �
Date
MWce: You may protest the Imposition of the fees Identified above by submitting a written proteM.to the District, In compliance with
Government Code Section 66020(a), within 90 days from the date fess are paid. Fallum to submit a timely wrltten protest wlll.prohibit
you from challenging the Imposition of the fees In any court action.
H, subsequent to the Schools District Representative signing this Butte County Schools Impact Fee CartMcation 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 districrs schools.
White (school district), Yellow (building department), Pink (applicant) feelorm.xis (3105)dtnm