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APPLICATION - LOT LIN <br /> T , .2 E ADJUSTMENT <br /> ice; s SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �. <br /> J. <br /> FILE NUMBER: <br /> FONCY,�NE:'t)�41NfR <br /> ..l l tt) u4 ori 1 ;I AX BILE_AAI AP..PL C,XfoN <br /> 1, the Owner/Agent agree, to defend, indemnify,i and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Ltruerty owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> his application, or <br /> (attach proof of the owner's consent to the application of the property's involved in this <br /> nd have been authorized to file on their behalf., and that the foregoing application statements <br /> correct. <br /> Banta-Carbona Irrigation District <br /> By: <br /> Print Name: David Weisenber�c er. ' �� <br /> GSigna#ure:General Manager Date:--,-';/ /SCG' C <br /> I <br /> Paul M.Gasta and Kathleen Gasta,trustees of the <br /> Paul M.Gasta and Kathleen Gasta Revocable Trust, <br /> dated August 1,2002 <br /> Print Name: Paul M.Gasta TrusteeSignature5/ <br /> l� 9 j��i ¢ ©ate: iv <br /> Print Name: Kathleen Gasta,Trustee <br /> Signature: Date: �/O <br /> i <br /> F\DEVSVCIPlanningApplication Forms\ Page 3 of 3 <br /> Lot Line Adjustment_doc.(Revised 6-4-04) Job No 2010-09 Lot Line Adjustment.doc <br />