HomeMy WebLinkAbout069-180-058BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building)
School, District Din V I' I D LLQBuilding Department No.
A.P. Number LAU f
Property Owner
Property Location/Address
Subdivision
County
Lot No.
.................... _._................................ ..... :......................................
Residential Development Q Q Q Sq. Footage
No of Living Mobile Home Addition/ 'Supplemental to (Group R)
Units Installation Conversion Permit #
•(Nofoundation inspecdon)
:..............................................................................................._...�
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Commercial/Industrial 0 0
Sq. Footage
Date
(Including Exterior
Roofed Areas)
District Identification No.
6 V- 1-1111' 1 k p Pt eco. School District certifies that
(A g icant) J
(Street Address) (Phone Number)
(City) (State) (Zip Code)
8�
has complied with the requirements of Resolution No. 0 —01 _t by payment of $ �� 2 q2
representing �' -:I-d square feet. AB 2926 $
FULL Mn1GATION $
School District Reoresenttllive Date
Paid by Check # Remarks: U (DQ
Notts: You may protest the Imposition of the has Identified above.by submitting a wrtttm protest to the District. In cornpllanee with
Government code Section 66020(a), within 90 days from the date hes are paid. Failure to submit a timely written protest wlll'prohibit
you from challenging the imposition of the hes In any court action.
il, subsequent to the School District Representative signing this Bulb County Schools Impact Fee Certification Form, the School District Is
no~ by the applicable Local Planning Agency thal this project Is being reviewed urder the CNHomla Enviroarnsnbl Quality Act (CEQAh
thispalm maybe subject to additional school has to hdy mlttgab.tts Impact on the school dhbk t schools.
White (applicant), Yellow (building department), Pink (school district)' feeform.xls (10/03)dmm