Laserfiche WebLink
f <br /> 4-14 <br /> U f'R o vAL <br /> APPLICATION - SITE AP <br /> PRIVATE RIGHT OF WAY-ANTIQUATED SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> d' <br /> ' AUTNORlZATlON'SlC3NATURES` � V' <br /> ' i,I•{ SII- I 'i <br /> a <br /> ' ION <br /> ' ONLY THETHEOWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN <br /> APPLICATION <br /> 1,the Owner/Agent agree, to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's protect. <br /> i <br /> 1,further, certify under penalty of perjury that l am(check one): <br /> Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s)fnvolved In this <br /> application,or <br /> O Legal agent(attach proof of the owners consent to the application of the property's Involved In this application and <br /> have been authorized to rite on their behalf.,and that the foregoing application statements are true and correct. <br /> Robert Lundbom Signature: I Date: 7/30/03 <br /> Print Name: <br /> ichelle Lundbom r> Date: 7/30/03 <br /> M <br /> Print Name: Signature: <br /> 7/30/03 <br /> Print Name: <br /> Brian Lundbom Signature: - Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signaturo: Date: <br /> I <br /> I <br /> I <br /> .I <br /> II <br /> 1 <br /> I <br /> I <br /> I <br /> I d <br /> I <br /> j <br /> ` s <br /> _ I <br /> i <br /> -5- <br />