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BUTTE,COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM f D
' ` . , �'; s' ,1• .y (One form per Building)
t:. School District Anif �F1'/ /'„ ii {�J�� . Building Department No.
A.P. Number Jurisdiction: I � City lCounty
Va //9 iw IP,
Property Owner,+
Property Location/Address f / 6< I. L,4
Subdivision Lot No.
Residential Development 01 �/ Q Sq. Footage
No of Living Mobile Home Addition/ 'Supplemental to (Group R)
Units Installation Conversion Permit #
*(No foundation Inspection)
i....................................................................................................i
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Commerdal/Industrial Q Q Sq. Footage
New Addition (Including Exterior
� ����� A '� / �• � n/ Roofed Areas)
1—to 6
Building Department Representative ' ', Date
°,-_
Di rict'Idlen/tfication No.
U6 016 4"
School District certifies that
[�
U) 6-'1 .
I .
oftpu')"' �3tzap, '
(Applicant) +
(Stre t Address) r U (Phone Number)
( )kp Vi P,040(00
Ci)
has complied with the requirements of Resolution No.
representing /I 9�(J square feet.
School District Representative (/
(State) (Zip Code)
by payment of $
2926 $
FULL MmGATION $ ..
. ✓ to y/o
Date
Paid by C;ieck # �} ./ Remarks: / �lvu�
t r
Notion: You may protest the Imposition of the toss Identified above by submitting a wMeWiprotest to the District, In compliance wfih
Government Cods Section 66020(a), within 90 days from the date Nes ars paid. Failure to.iubmlt a timely written protist wlll'prohlblt
you from challerrghng the Imposltlon of the Nes In any court action.
N, subsequent to the School District Represented" signing this Butte Courtly Schools Impact Foo Certification Form, the school District Is
rrotilled by the applicable Local Planning Agency that this project Is being rwlawed under the cal"i mla Environmental Quality Act (CEQA)
this prtnject rosy be subject to additional school Nes to fully nrtlgate:lls Impact on the school dlstAdls schools.
White (applicant), Yellow (building department), Pink (school district) feeform.xts 00/03)dmm
.BUTTE,C_QUNTY DEVELOPMENT FEE CERTIFICATION FORM
ff FEATHER RIVER RECREATION AND PARK DISTRICT (FRRPD
❑ CHICO AREA RECREATION AND PARK DISTRICT (CARD)
❑ PARADISE RECREATION AND PARK DISTRICT (PRPD)
0 DURHAM RECREATION AND PARK DISTRICT (DRPD)
Assessor Parcel Nurn
Property Owner (s)_i
Project Location /Address
Subdivision Name
Building Permit NumberJ6_(/1//4
Assessable Sq. Ftge y.1,/6
Type of Residential Development (check one)
_ZNew Development Single Family -Detached Single Family -Attached
Alteration/Addition(s) Non -Residential to Residential Multi -Family Dwelling
_ Mobile home Mobile home replacement verified by Assessor Department
Demo Permit (date issued ) verified by Building Department
Comments:
>F FRRPD 0 CARD ❑ PRPD ❑ DRPD certifies that:
Applicant Name Phone Number '
-3 ano&-y V_cvia, \/ C?al vcA _ ovoy � 1 e C/-- IS"l(aS
Mailing Address City State Zip
Has complied with requirements of the Butte County Board of Supervisors Resolution No.
by Payment of`-
Dwelling Units @ $ 00 per unit for a total of $ �� •- C9C7
Square Feet @ $ per sq foot for a total of $
Remarks:
Paid by Check No: > }Paid by Cash:
Park District Representative
Y drnU I, R C%0 i ITT T TT.i(: rnn%n Q%- --I, -.-,--A —A 1 Ann
Receipt No:
Date
1`1
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