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i <br /> YoQ` t,eo APPLICATION - LOT LINE ADJUSTMENT <br /> y <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4 FILE NUMBER: <br /> Eo i <br /> AM <br /> �j§r � ° %!1 �,.�, Eg6 •t�9 �g '" .. %',p; <br /> aSsM >i,'.°4'jr "�.qi�� :: ,,- :e a. I I _'ui6°sP`r`,[o;o, :.�,tt �ika:': ii1="€«.. a.k,E ,.{i3ia A¢<.€E€ii(gi€,f"3 <:€a..s•<. - ..o., •s.;�.�:- <br /> 3+�.y �y , ... y�y» ,� yk'�yla�y y� �'§•§�y <br /> E �� CF...;T._. IFeR,.# .f l i �l�RiZ ® G II1Lk1 :L"1T ?1 �✓# '�#3 •'•i <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 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 the application of the property's involved in this <br /> application cation and have been�autharized to file their pp on t eir behalf., and that the foregoing application statements <br /> g 9 PP <br /> are true and correct. <br /> Print Name: George Te Velde Signature: Date: 1—/Zd7 <br /> Print Name: Elizabeth Te Velde Signatur Date-. O <br /> Print Name: George Te Velde Jr. Signature Date: <br /> Print Name: Margot Te Velde Signa tu i Date: <br /> Print Name: Signature: Date: <br /> 1. <br /> f <br /> F'MEMCOanning Applkcatlon Formsl Page 5 of 7 <br /> Lot Line Adjustment,doe.(Revised 6-404) <br />