Form Ds-340 - Application For Extension Of Time For Grading/right-Of-Way Permits - City Of San Diego Development Services -2013
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Application for
City of San Diego
Development Services
DS-340
Extension of Time for
1222 First Ave., MS-302
San Diego, CA 92101
Grading/Right-of-Way Permits
(619) 446-5000
M
2013
ay
This form shall be used to apply for an extension of time for a Grading and/or Public Right-of-Way Permit which has not
expired. If a Grading and/or Public Right-of-Way permit expires before an application for an extension of time is submitted, an
extension shall not be granted. A permittee may submit an Application for Extension of time no earlier than 60 calendar days
before the Permit Expiration date. The permit may be extended for a period not exceeding 180 calendar days per San Diego
Municipal Code Section 129.0651 and 129.0751. If an extension of time has been previously approved, an additional 180 day
extension may be granted per San Diego Municipal Code Section 129.0651(d) and 129.0751(d). This completed application may
be mailed or delivered to the address above. Attention: Project Processing Section.
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1.
Approval Type Requesting Extension of Time for:
Grading
Right-of-Way
Grading & Right-of-Way
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2.
Request:
1st Extension
2nd Extension
3. Project Address/Location:
Project Number:
4. Approval Number:
Expiration Date of Approval:
5. Reason for Extension Request:
6.
Requested by: (must be Record Owner or Permit Holder as listed on the Permit)
Name:
Telephone:
Fax:
Address:
City:
State:
Zip Code:
E-mail Address:
Signature:
Date:
SURETY ACKNOWLEDGEMENT
(Must be completed if Performance Bond was provided as surety on the permit)
(Surety Company) __________________________________________________________ is aware that the principal on Surety Number
________________________ is applying for an extension of time in which to complete the work on the above referenced project/ap-
proval and has no objection to such extension. Surety Company also acknowledges that this surety will remain in full force and
effect as security for the performance of this obligation.
Name of Surety Agency: _____________________________________
Attorney In Fact: ____________________________________
SIGNATURE
Address: ______________________________________ City: _________________ State: ________
Zip Code:
_______________
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Surety Not Applicable
Letter of Credit Attached
FOR CITY USE ONLY
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Approved
1st Extension
2nd Extension
Extension of Time Granted to: ___________________________
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Denied Reason: ___________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
Staff Name: _________________________________ Signature: ____________________________ Date: _________________________
NOTE: SURETY SIGNATURES MUST INCLUDE NOTARY ACKNOWLEDGMENTS PER CIVIL CODE SEC. 1180 ET.SEQ.
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Upon request, this information is available in alternative formats for persons with disabilities.
DS-340 (05-13)
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