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TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Applicant Information <br /> N39,,e <br /> Address: <br /> CA , 1-rZI-Ir <br /> Phone. i73 <br /> Permit Information <br /> Permit Numberrs): -- - -- -DateApproved- <br /> Approving Agency: Staft Planning Cammission Board of Supervisors <br /> Expiration Date I Extension Requested on <br /> Give the reason for the request for a tm a e't"Sw:include the circumstances that have ptevented the project from preceding on <br /> schedule: <br /> jai <br /> 6e7 � ceCort <br /> O <br /> Hovv much additional time is being requested: —_ <br /> NOTE Time E>ter, = can be granted for up to t year for development apphcations and up to 5 years for subdivisions. <br /> SIGNATURE <br /> Signature- y Date n <br /> SIGNATURE <br /> Foe No..- r_ <br /> R -aipt 1s D. <br /> Accepted b_:. — —i ,0 z._ <br /> F Page 2 of 2 <br /> IL 00 1 ZV <br />