HomeMy WebLinkAbout069-150-033BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Bull.dIng)
School District Building Department No.
V
A.P. Number Jurisdiction:e County
Property Owner
Property Location/Address
Olt pc;y-,(
b
Subdivision
Lot No.
Residential Development
Xile
................................................................
0
.......................................
Q -§q. Footage
No of Living Mo Mme
Additiont
*Supplemental to
(Group R)
Units Installation
Conversion
- Permft#�
........................................................................
*(No foundation Inspection)
! ......................._..:i
Deed Restricted Sq. Footage
(Attach a signed copy
of Deed Restriction and Notice of Limited Use Facility document)
Commerciial/Industrial
New Addition
Building Department
Sq. Footage
J
(Including Exterior
Roofed Areas)
9
Date
C.
District Identification No. to S I+ 6
u -a JL School District certifies that
(Applicant)
(Street Address) l (Phone Number)
r -a If e—
(City) (State) (Zip Code)'
has complied with the requirements of Resolution No. 2—co by payment of $
representing 0 square feet. 2926 $
FULL MITIGATION $
School Mtrict(Oopresentative Date
Paid by Check. # Remarks- 3
sa
Notice: Yom may protest the InMioslition of the ton klentilled above by submitting a written n proteatto the District. In compliance with
Gova t. iont Code Beetle 66020(a), wMn 90 days from the date fen are paid. Failure to submit a timely written protest vAll'prohh*
you from chalWiging the Imposition of the flies In any court action.
If. subsequent to the School District Relpresentative signing this Butts County Schools Impact Fee Cartiftstlon Fom% the School District Is
WIN by the aWicaW Local Planning Agency 00 this project Is being reviewed wider the California Environmental (buititty Act (CIEQA).
this project a" be subject to addiftlonal school fees to fully n0gaft.11ts Impact on the act" districtle schools.
White (apalican% Yellow (building department), Pink (school district) feeform.)ft 001031 imm