Development Agreement Supplemental Form

City of San Diego

Development Services

1222 First Ave. 3rd Floor

San Diego, CA 92101

(619) 446-5210

Printed on recycled paper. Visit our web site at www.sandiego.gov/development-services.

Upon request, this information is available in alternative formats for persons with disabilities.

DS-3038 (06-13)

Development Agreement

Supplemental Form

FORM

DS-3038

June 2013

California Government Code sections 65864 et al. and Land Development Code Chapter 12, Article 4, Division 1 pro-

vide for a process for review and approval of Development Agreements. This form is required upon submittal of an

application to request a Development Agreement and is intended to supplement the General Application form.

1. Applicant Name: E-mail Address:

Address: City: State: Zip Code: Telephone:

2. Property Owner Name: E-mail Address:

Address: City: State: Zip Code: Telephone:

3. Site Address/Assessor’s Parcel Number where Development Agreement is requested:

Address/APN: Zip Code:

4. Identify whether the Development Agreement will impact the following. If the answer is yes, identify the asso-

ciated impact or beneﬁt in the space provided.

Circulation Facilities ❏ Yes ❏ No _________________________________________

Parks ❏ Yes ❏ No _________________________________________

Schools ❏ Yes ❏ No _________________________________________

Water ❏ Yes ❏ No _________________________________________

Police Protection ❏ Yes ❏ No _________________________________________

Fire Protection ❏ Yes ❏ No _________________________________________

Trash Disposal ❏ Yes ❏ No _________________________________________

Sewage Disposal ❏ Yes ❏ No _________________________________________

Hazardous Waste Disposal ❏ Yes ❏ No _________________________________________

Air Quality ❏ Yes ❏ No _________________________________________

Public Libraries ❏ Yes ❏ No _________________________________________

Low-income and Affordable housing (as deﬁned by the Housing Commission) ❏ Yes ❏ No _________________________________________

Airports

❏ Yes ❏ No _________________________________________

Project No.: __________________

5. Identify the type and size of development that would be covered and the requested duration of the develop-

ment agreement.

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6. Identify the public beneﬁt that will result in excess of what can be obtained under existing policies and regula-

tions.

7. Identify how the project will comply with Council Policy 300-10 (Equal Opportunity) and Council Policy 800-15

(Equal Opportunity Contracting).

8. Identify how the project will comply with Council Policy 600-19 (Balanced Communities) and Council Policy

600-20 (Open Housing Policy).

9. Please attach any documents that you feel are necessary to support your request for a Development Agree-

ment.

10. Property Owner Declaration: I ____________________________, certify, under penalty of perjury under the

laws of the State of California, that the information provided above is correct.

Signature: _________________________________________ Date: _____________________

Project No.: __________________

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