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CITY OF MODESTO Community and Economic Development Department/Planning Division 1010 Tenth Street, Suite 3300, P.O. Box 642 Modesto, CA 95353 (209) 577-5267 Updated 7/15/2024 Administrative Approval Application Note: In order for Applications to be deemed complete under Section 65943 of the Government Code, the following items must be provided: 1. Completed Administrative Approval Application 2. Development Plans as required by Submittal Requirements – http://modestogov.com/1561/Planning-Forms-and-Applications 3. Appropriate Filing Fee – Must be paid at time of submittal. GENERAL REQUIREMENTS (Print or Type) Address or Location of Property: Assesor's Parcel Number(s) Current Zoning: **Applicant Name: Address: Contact Contact E-Mail: **Applicant’s Representative: Address: Contact E-Mail: Note: If the applicant is not the property owner, the property owner shall designate the applicant as the authorized agent/ representative to act on his or her behalf and both shall sign this application. TYPE OF APPLICATION Second-Story Addition 1 Time Extension Director Determination Minor Development Plan Review Street Address Addition or Change 1 Refer to Second-Story Addition Submittal Requirements 2 Pursuant to Section 10-7.108 Address: E-Mail: Property Owner Name: Gen. Plan: File No.: Received by: TrakIT Case No: BLD No.: STAFF USE ONLY Date: / / Zoning Verification Letter Minor Plan Revisions P-D Zone Amendment 2 ---PAGE BREAK--- City of Modesto Administrative Approval Application Page 2 of 2 Description of surounding areas: AFFIDAVIT If property owner is a trust, partnership, LLC, etc. the signature shall be from a corporate officer. Attach Letter of Authorization or other proof. I, hereby certify that I am the applicant in the foregoing application, that I have read the foregoing application and know the content thereof and state that the same is true and correct to the best of my knowledge. Applicant (signature) Applicant (print name) I, hereby certify that I am the owner (if other than the applicant) of real property involved in this application, do hereby consent to the filing of this application. Attach separate sheets if multiple property owners. Owner (signature) Owner (print name) Residential Commercial PROJECT DESCRIPTION (attach additional sheets if necessary) Description and purpose of request: In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website: Updated 7/15/2024 Other (example: To the West is a gas station, To the East is a Multi-Family apartment complex, etc) SIGN SIGN