HomeMy WebLinkAbout069-190-007School District
A.P. Number
Property Owner
BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(One form per Building) V T
Building Department No.
U 1 oC1 lciy • U Jurisdiction: "' Q City County
Property Location/Address
Subdivision
Residential Development Q
No of Living M$tallalaon
me
Units I
Commercial/Industrial Q Q
I New Addition
>Y �
1
V Lot No.
......... ..... .... ... ...................................... :................................ _....
Sq. Footage I ��
Addition/ 'Supplemental to (Group R)
Conversion Permit #
*(No foundation inspection)
..................................................................... .........................i
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Sq. Footage
(Including Exterior
Roofed Areas)
.� •v t
Date I !
District Identification No. 65;1-1)
Uw r.T�l� (t?s� School District certifies that
Le -k �.,
(Applicant)
(Street Address) V (Phone Number)
q
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. 0 t' c �L--LO
representing 5 O square feet.
",W
School District
by payment of $ L+ u 1 �- 5 b
2926 $
FULL MITIGATION $
Paid by Check # Remarks: C o k —k O o )
Date
Notice: You may protest the Imposition of the fess Identified above by subnnitting a written protest to the District. In compliance with
Govsmmant Cods Section 66020(a), within 90 days from the data fess are paid. Fallun to submit a timely written protest will'prohlblt
you from challenging the Imposition of the fess In any court action. .
K, subsequent to the Stool District Representative signing this Sutte County Schools Impact Fee Certification Form, the School District Is
notlRed try the appiir:abla Local Planning Agency that this project Is Ming nvlswsd under the California Environmental Quality Act (CEQA),
this projsa- may be subset to additional school fess to fully mitigate. its Impact on the school diatrlcNt schools.
White (applicant), Yellow (building department), fink (school district) feeform.)ft (10/03)dmm