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aQ'.lN APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, 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 /> 1, further, certify under penalty of perjury Ihat 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 the application of the property's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Robert Chinchiolo Signature: Dat <br /> Print Name. Francis P. Ch i nch i a l oSignature:� -/'�f Date: Z3 f[J <br /> Print Name: Sally Lewis Signature: _ Date: Q <br /> Print Mame: Signature. Date: <br /> Print Name: Signature: Date: <br /> E <br /> F:0r:VSVCkRanni%Applicallon Formsti Page 5 of 7 <br /> Lot une Ad)uWment.doc.(Revised 6-A-04) <br />