HomeMy WebLinkAbout068-330-021BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
/ //(One Form per•Building)
A.P. Number JQ� --3'3 - Building Department No.
School District D ro vk��'e City Q County �' Jurisdiction
Property Owner
Project Location/Address
Subdivision
Residential Development:
# of Living MHI
Units
Lot Number
� Sq • • FootageI CJ�
Addition (Group R)
Commercial/Industrial: Sq. Footage
New Addition (Including Exterior
Roofed Areas) '
Building Department Representative Date
t
R.
District Id No. 00 %J
School District certifies that
`(Applicant Name) (Phone Number)
(Street Address)
&�
(City) (State) (Zip Code) `
has complied with the requirements of -Resolution No.
by the payment of $ c2a to � representing 5�9_ 7 square feet.
,/
'School Disy "t Representative bate
PAID BY CHECK NO. /
BANK NO
REMARKS:*
PAID BY CASH
white -applicant, yellow -building department, pink -school district
SCHOOL . FEE (5/88)
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