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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One Form Per Building)
School District Building Department No.
A.P. Number 0(9- /040 oi- Jurisdiction City 1PKz-1
Countyf,
Property Owner AN►es JU -#-e rt'!el
Property Location/Address 37 �Aeu* e
Subdivison Lot No.
4
Residential Development 0 0
Sq. Footage' S -7
No. of Living MHI Addition
(Group R)
Units
Commercial/Industrial
Sq. Footage
. New Addition
(Including Exterior
Roofed Areas)
y /f--3
Building,epartment Representative
Date '
(Floor Plans reviewed by School District Personnel)
District Identification No.
School District certifies that
! ��
v
(Applicant)
,
3.1 V� t
I,L/�
(Street Address),
(Phone Number)
.(CRY) (State)
(Zip Code)
has complied with the requirements of Resolution No. by payment. of $
representing square feet.
School District Representative
Date
Paid by Check Number Remarks: lG Aml.
Bank Number o.- 9.0-3&0 7 -
Paid by Cash
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee r
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) feeformmkf (4/92)