COMMUNITY DEVELOPMENT APPLICATION FOR EXTENSION OF

117 NW Lafayette Avenue, Bend, Oregon 97703 | P.O. Box 6005, Bend, OR 97708-6005

(541) 388-6575

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.org www.deschutes.org/cd

Rev 5/18

COMMUNITY DEVELOPMENT

File No. 247-________________________

APPLICATION FOR EXTENSION OF A LAND USE PERMIT

FEE: __________

Applicant’s Name (print): ______________________________________________ Phone: (____)

Mailing Address: City/State/Zip:

Property Owner’s Name (if different)*: Phone: (____)

Mailing Address: City/State/Zip:

Nature of Application:

Property Description: Township______ Range_______ Section_______ Tax Lot

Deschutes County Application Number:

Date of Approval: __________________________________ Permit Expiration Date:

Property Zone:

On the reverse side, or on a separate sheet of paper, please respond to the following:

1. Describe any action that has been taken to fulfill any or all conditions of approval.

2. Describe the reason(s) for not beginning or continuing development or meeting conditions

of approval within the approval period.

Applicant’s Signature: Date:

Property Owner’s Signature (if different)*: Date:

Agent’s Name (if applicable): Phone: (____)

Mailing Address: City/State/Zip:

*If this application is not signed by the property owner, a letter authorizing signature by

the applicant must be attached.

(over)