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' BUTTE COUNTY SCHOOLS DEVELOPMENT FEE CERTIFICATION FORM
(One Form per Building)
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A.P. Number ��- fa- �% Building Department No.
School District City 0 County ® Jurisdiction
Property Owner
Project Location/Address o�vT 9 OYOuIe �� 2pc�(
I%
Subdivision`' Lot Number
1
Residential Development: �r
Sq. Footage o�
# of iving MHI Addition (Group R)
Units i
Commercial/Industrial: Sq. Footage
New+. Addition (Including Exterior
Roofed Areas)
Building Department Representative Date
i
District Id No. 004 i '
-4School District certifies that
L.J
(Applicant Name)(Phone Number)
ad 9 A0
%
(Street Addre" s )
(City) (State) (Zip Code)
has complied with the requirements of Resolution No.
052
by the ayment of $ 3 Z?d representing asaysquare feet.
9r �
School D,Ypict Representative - Date
PAID' BY CHECK NO. /
BANK NO q0- %Y % 7
PAID BY CASH
REMARKS:
white -applicant, yellow -building department, pink -school district
SCHOOL . FEE (5/88)