HomeMy WebLinkAbout069-180-002BUTTE COUNTY SCHOOLS IMPACT FEE. CERTIFICATION FORM.
(One form perbulldthg)'
School District Cr 0 t/', I t I el yr �OK4'1 t -4 Building Department No.
A.P. Number\Ij city
Jurisdiction: County
Property Owner
Property LocatlorJA
division
1 ()10- /qo":7
Residential Development
No of Living
Mobile Home
Units
Installation
"'4""dommercial/Industrial
New Addition
Lot No.
.............. . ..... ...... ............................................................... ...
Sq. Footage
Addition) *Supplemental to (Group R)
Conversion Permit #
*(No foundation inspection)
......................... ... ....
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Distirict Identificalikin* No.
op A=, School District certifies that
Sq- Footage
(Including Exterior
Roofed Areas)
Date
*-- J6'SV--'
k
OC:4=d 9E--6 %4
(Applicant)
(Street Address) (Phone Number)
ot
,(City) (State) (Zip Code)
has complied with the requirements of Resolution No. by payment of $ ro"
representing fl l to square feet. 2926 $
FULL MMGATION $
'School District Represedtative Date
Paid by Check # Remarks: t2 ;-!k
6% 1% -0
Natke: You may protest: the Impooltim of the fen Identified above by submitting a written protest to the District, In compliance with
W.Government Code Section 66020(a), within 90 days from the date fen are paid. Failure to submit a timely written wili'pmhh*
y,;uriorn challenging the imposition of the fees In any Doom actim
9, subsequent to the School District RepnssMatlw signing this Butts County Schools Impact Foe Certification Form, the School District Is
adil by the applicable Local Plitrining Agency 00 this prood Is being revlsaed under the California Environments! Quality Act (CEQAL
tits po am A may be sulodto additional school fen to fully mitigate. s Impact on the school dist acre schools.
White (applicant), Yellow (building department), Pink'(school district) feeform.)ds (10/03)dm.m
Q
4xr
V w
k -z I I I I 0,�
4H
L
LA4 'ioW 47 �4,
12-avi s ft o N � To
BUTTE GCWA-TY
BUILDING DIVISION
PRIl
p -
oil
�i�
m
wo
r
43
TU6
ANIG XTT.. COPY
'Aw