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;'. APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> rg � FILE NUMBER: <br /> I <br /> r �► ��Of���AT10N`SIG�AT �S <br /> ONLYTHE �WNf=R O TH��P <br /> W <br /> ROPE.R"f C,; F Afd;,AUS"f Qi�f. E ® ,4ta f T,1VfAY,F LE..A[�I AW-PI.fCATION, <br /> I1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> I employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ® Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or. <br /> Legal agent (attach proof of the owner's consent to thea application of the roe <br /> pp property's rty's involved in this I� <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> I <br /> I <br /> APN 247-020-23:Joe A.George Trust <br /> Print Name: Stanley George,Administrator Signature: Date: _718 <br /> E <br /> APN 247-020-24: Stanley George, Douglas George and Kathy <br /> I <br /> Print Name: Stanley George _ .._ Signature: Date: <br /> �I Print Name: Douglas Geor a Signature: Date: I <br /> Print Name: Kathv Reisenbeck ,_ Signature:> Date: <br /> Pride: Signature: Date: {{ <br /> 10EVSVDPfann;ng Application Forms\ Page 3 of 3 Job No 2011-107 Lot Line Adiustment.doc <br /> Lot L'ne Adjustment,doo.fFievlsed e-4-04) <br />