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2• {—C�r y 1 <br /> APPLICATION - TIME EXTENSION <br /> SAM JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: TE- <br /> TO BE COMPLETED BY.THE APPLICANT PRIOR TO-FILING THE APPLICATION - <br /> Applicant Information <br /> Name: <br /> " I <br /> Address: Grl <br /> Phone. <br /> Permit Information <br /> Permit Number(s): _ - - Date Approved: <br /> Approving Agency: -❑ Staff ❑ Planning Commission ❑ Board of Supervisors <br /> Expiration Date: - - Extension Requested on: <br /> Give the reason for the request for a time extension(include the circumstances that have prevented the project from preceding on <br /> schedule: <br /> How much additional time is being requested: <br /> NOTE: Time Extensions can be granted for up to 1 year for development applications and up to 5 years for subdivisions. <br /> SIGNATURE <br /> Signature: 'y,� '7Z Date: C- - <br /> SIGNATURE <br /> . . <br /> File No: �"'-� <br /> Accepted b ' <br /> P Y: Li b 1!,' Date: j- <br /> J <br /> F T)rVSVCnanning Application Foms\ Page 2 of 2 <br /> Time Extension.doc(Revised 10-19-04) <br />