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BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
'(One Form per Building)
A.P. .Number �p9��D 'Q�� Building Department No.
School District 0 City D County Jurisdiction
Property Owner L AV F -A IGN 414L)L01tiI
Project Location/Address— 0A17-WO59 D%L C.J 9'S"g�
Subdivision A-"ELLI 4112&C-- F14;7"- Lot Number 0 S�
Resideni-al Development: 1
.,.''�[ �` a � Sq. Footage 5oC
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: Sq. Footage f
New Addition (Including Exterior
Roofed Areas)
Buildi g Department Representative Date
(F1oor.Plans-reviewed by School l• District Personnel)
District Id No. la J 9
v
p (Applicant Name)
O Cm
School.District certifies that I
Phone Number)
(Street Address)
. a _
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. J— To 0
by the payment of $ x2411)1Virg presenting�j a square feet.
School Di ict Representative Date
PAID BY CHECK N0. ��
BANK NO i 1' 40 7%
PAID .BY CASH
REMARKS:
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)