HomeMy WebLinkAbout069-190-001BUTTE. COUNTY SCHOOLS IMPACtT FEE CERTIFICATION FORM
(One form per Building)
School District Building Department No.
A.P. Number 440✓1
fD ��� Jurisdiction: City County
Property Owner E!l M -'I
i
Property Location/Address �P�J + �J �i� ' Alen
Subdivision
Residential Development
No of Living Mobile Home
Y Units Installation
Commercial/Industrial
New Addition
Lot No
..................................................................................................................
Sq. Footage 1714
Addition/ 'Supplemental to (Group R)
Conversion Permit #
i '(No foundation inspection):
................................................................................................. x
S
Sq. Footage:
moor rians revlewea oy bcnool uistrict Personnel)
Date
(Including Exterior
' Roofed Areas)
District Identification No.
School District certifies that
V _ 4- 1 (Applicant)
(Street Address)
(City)
has complied with the requirements of Resolution No
representing 1-716 square feet.
School District Representative
Paid by Check # �„�. Remarks:
(Phone Number)
�159�
JZip Code)
by Payment of $'% SO
J�AB 2926 $
FULL MITIGATION $
Date
Notice: You may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance with
Government Code Section 660201a), within 90 days from the date fees are paid. Failure to submit a timely written.protest will prohibit
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is '
notified by the applicable Local Planning Agency that this project is being reviewed under the Califomiw Environmental Quality Act (CEGA),
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). feeform.xls (10/98)dmm
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