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Method of impact fee payment Cash Personal Check Check Certified Check Check Money Order Other specify Receipt Issued By Signature Printed Name Title Department Signed copy provided to Agent Other please describe Reference Codified Ordinances 1486. FORM C - RECEIPT FOR IMPACT FEES PAID APPLICATION NO. CITY OF PICKERINGTON OHIO BUILDING DEPARTMENT 100 LOCKVILLE ROAD PICKERINGTON OH 43147 614 837-3974 FAX 614 833-2201 website address http //www. pickerington*net office use To be completed by City Staff* Note In the event of an inconsistency between this form and the Codified Ordinances the Codified Ordinances govern* 1. Project Information ZONE DISTRICT AUDITOR S PARCEL LOT NO. Date 2. Subdivision Project Development Name 3. Applicant / Owner Information Property Owner - Who owns the land Street Address / City / State / Zip Phone Number Architect / Engineer /Surveyor/ Contractor - Plans by Applicant - Who is handling the permits Building Permit Application s Date of building permit application s Amount of impact fee paid Parks Recreation Facilities impact fee Police Facilities impact fee Government Facilities impact fee Street impact fee TOTAL FEES Total must equal Total fee calculated in Form B H0598986. 1 If impact fee payment is 0 indicate one of the following the Applicant has been granted a full Credit. of the impact fee owed as calculated in Form B and as approved by the City Attorney and City Manager has been posted with the City. the proposed development does not result in the demand for Public Facilities as provided in Chapter 1486. FORM C - RECEIPT FOR IMPACT FEES PAID APPLICATION NO. CITY OF PICKERINGTON OHIO BUILDING DEPARTMENT 100 LOCKVILLE ROAD PICKERINGTON OH 43147 614 837-3974 FAX 614 833-2201 website address http //www. pickerington*net office use To be completed by City Staff* Note In the event of an inconsistency between this form and the Codified Ordinances the Codified Ordinances govern* 1. pickerington*net office use To be completed by City Staff* Note In the event of an inconsistency between this form and the Codified Ordinances the Codified Ordinances govern* 1. Project Information ZONE DISTRICT AUDITOR S PARCEL LOT NO. Date 2. Subdivision Project Development Name 3. Project Information ZONE DISTRICT AUDITOR S PARCEL LOT NO. Date 2. Subdivision Project Development Name 3. Applicant / Owner Information Property Owner - Who owns the land Street Address / City / State / Zip Phone Number Architect / Engineer /Surveyor/ Contractor - Plans by Applicant - Who is handling the permits Building Permit Application s Date of building permit application s Amount of impact fee paid Parks Recreation Facilities impact fee Police Facilities impact fee Government Facilities impact fee Street impact fee TOTAL FEES Total must equal Total fee calculated in Form B H0598986. Applicant / Owner Information Property Owner - Who owns the land Street Address / City / State / Zip Phone Number Architect / Engineer /Surveyor/ Contractor - Plans by Applicant - Who is handling the permits Building Permit Application s Date of building permit application s Amount of impact fee paid Parks Recreation Facilities impact fee Police Facilities impact fee Government Facilities impact fee Street impact fee TOTAL FEES Total must equal Total fee calculated in Form B H0598986. 1 If impact fee payment is 0 indicate one of the following the Applicant has been granted a full Credit.

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Keywords relevant to Impact Fee Receipt

  • ordinances
  • surveyor
  • inconsistency
  • exemption
  • auditor
  • Subdivision
  • Applicant
  • specify
  • GOVERN
  • parcel
  • recreation
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