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P ©� `APPLICATION - LOT LA; <br /> E ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> gtifia=i <br /> FILE NUMBER: <br /> 1 <br /> 1 <br /> - �"F <br /> 1 i Kl <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proce'e'ding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one: <br /> X Legal property owner1(owner includes partner, trustee, trustor or corporate officer) of theproperty(s) involved in <br /> this application, or I <br /> Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print <br /> Name: Willis W. Heinrich Signature: P <br /> � Date: <br /> Print j <br /> Name: Gladys Heinrich I Signature: ' Date: 6/S <br /> Print ' <br /> Name: Larr�l L SDate: <br /> ;dlivan,Trustee Signature: t z Q 7 <br /> Print <br /> Name: <br /> Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> 1 <br /> I <br /> J <br /> F:DEVSVC/Planning Application Forms/ <br /> Lot Line Adjustment doc. (Revised 06-04-04) Page 3 of 3 Job No 2005.111 <br /> 1 <br />