HomeMy WebLinkAbout069-180-033BUTTE COUNTY SCHOOLS DEVELOPMENT -FEE CERTIFICATION FORM
(,One Form`per Building)'
A.P. Number -64:7- 142 cP3 Building Department No.
Schocl'District Q ". City a County Jurisdiction
Property: Owner 6 -CAA: Q
Project Location/Address
Subdivision kD\l CCF �- 1`I TGC J Lot . Number. ..��
Residential,Development: aa
a Sq. Footage
# of ;ijving MHI Addition (Group R)
Units
Commercial/Industrial: O Sq. Footage
New Addition (Including Exterior
Bui
Roofed Areas)
r /Date
(Floor Plans .reviewed by School District Personnel)
D_strict*Id No..
-, School District certifies•that
Ql
XL�-X % t -L-t�
(Applicant Name) (Phone Number)
/97
( Stre��e^^t . Address )
(City) (State) (Zip Code)
has complied with the requirements of Resolution No./�-
bv
by the payment of $ :::R /D !o representing /y0 !square feet.
School Dist,'Pi.dt Representative Date"
PAID BY CHECK NO.
BANK NO I�
REMARKS:
PAID BY CASH
white-appl-icant, yellow -building department, pink -school district
SCHOOL.FEE '(8/88)
0