HomeMy WebLinkAbout072-340-009BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
(O form per Building)
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W�
Department Representative
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Sq. Footage
(Including Exterior
/Roofed Areas)
Date
District Identification,No.
C,ILc� School District certifies that
v
Q
(Applicant)
(Street Address) '. (Phone Number)
Building Department No.
School District
/
(City)
(State)
y
has complied with the requirements of Resolution No.
A.P. Number
Jurisdiction:psi
County
S
Property Owner
representing (o� square feet.
JAB 2926
i
Property Location/Address
'
FULL MITIGATION
=
Subdivision
School District,Representative
Lot No.
Date
Paid by Check # Remarks:
...........................................................:......................................
Residential Development
Q
Q
Q Sq. Footage
No of Living
Mobile Home
Addition/ 'Supplemental to (Group R)
Units'
Installation
Conversion Permit #
*(No foundation inspection)
................................................................................................ _ ... i
=l
W�
Department Representative
Deed Restricted Sq. Footage
(Attach a signed copy of Deed Restriction and Notice of Limited Use Facility document)
Sq. Footage
(Including Exterior
/Roofed Areas)
Date
District Identification,No.
C,ILc� School District certifies that
v
Q
(Applicant)
(Street Address) '. (Phone Number)
Notice: You may protest the Imposition of the fees Montt tisd above by submitting a written protest to the District. In compliance with
Government Code Section 66020(a), wWdn 90 days from the date fess am paid. Failure to submit a timely written protest wlll'prohlbit
you from ebllerrping the Imposition of the tees in any court aetlon.
M, subsequod to the School District Representative signing this Bulb county Schools Impact Fee Certification Form, the School District Is
rrotlSed by the applicable Local Planning Agency that this prolset labeing solew under the CaUfands Environments! QualMy Act (CEQA1
this project may be subject to addMbnal school fees to hdy mitigate. its Impact on the school distrletle schools.
White (applicant), Yellow (building department),, Pink (school district) feetorm.x% (10/03)dmm
(City)
(State)
(Zip Code)
has complied with the requirements of Resolution No.
Q 3 -0—/'�
by payment of $
'
representing (o� square feet.
JAB 2926
i
'
FULL MITIGATION
=
School District,Representative
Date
Paid by Check # Remarks:
p�
Notice: You may protest the Imposition of the fees Montt tisd above by submitting a written protest to the District. In compliance with
Government Code Section 66020(a), wWdn 90 days from the date fess am paid. Failure to submit a timely written protest wlll'prohlbit
you from ebllerrping the Imposition of the tees in any court aetlon.
M, subsequod to the School District Representative signing this Bulb county Schools Impact Fee Certification Form, the School District Is
rrotlSed by the applicable Local Planning Agency that this prolset labeing solew under the CaUfands Environments! QualMy Act (CEQA1
this project may be subject to addMbnal school fees to hdy mitigate. its Impact on the school distrletle schools.
White (applicant), Yellow (building department),, Pink (school district) feetorm.x% (10/03)dmm
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