HomeMy WebLinkAbout069-100-037
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BUTTE COUNTY SCHOOLS IMPACT FEE'CERTIFICATION FORM
J.
(One form per Building)
School District ` / Q U j I11 1 1 bf V1 Building Department No.
A.P. Number �44- mo -(13 Jurisdiction: City County
Property Owner _ , � � �/enne ('S4 e 1 .
Property Location/Address G P 0,1A
Subdivision Lot No.
Residential Development
No of Living
�N, ` Units
Commercial/Industrial - 0
i New
:..................................................................................................................
EKI^~ Sq. Footage 1
Mobile Home Addition/ *Supplemental to (Group R)
Installation Conversion Permit #
"(No foundation inspection):
...............................................................................................................
Addition
(Floor Flans reviewed by School District Personnel)
Sq. Footage
(Including Exterior
Roofed Areas)
Date
/bstri ot Identification No.
School District certifies that
Applicintf
(Street Address)
(Phone Number)
(City) - (State) (Zip Code)
has complied'with the requirements of Resolution No.' 9/! -0Q -e%5— by payment of $ -27 5 -U
representing 131:pq- square feet.
School District Representative
4
Paid by Check ✓r
. Remarks:
AS 2926 $
FULL MITIGATION $'
Date
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 660201a), within 90 days from the date fees are paid. Failure to submit a timely written protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools 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) feeformAs (10/98)dmm
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