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J <br /> .-APPLICATION _ LOT UNE ADJUSTMENT <br /> � •`, ,,4 q ,4 z SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �r .. •-'P� FILE NUMBER: <br /> �► .lTHORI ►` O`N€S �G11�A Piet} �S'> <br /> �r <br /> ONLY THE-RW-IVE-R QF; 'FIE,PR{�PER`I' ORA,142 iD�ftZEQ�AG�N f��MAY FILL AN.,APP <br /> LJ <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim,traction or proceeding against the Owner/Agent's project. <br /> t <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 /> I <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: Julio Feri,Trustee Signature: r f Date: ^ fS <br /> Print Name: Helen Arnaudo Trustee Signatur �-_ ' <br /> . , GG �z <br /> Print Name: Helen Arnaudo Signature: -[ Date:-r�' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADFVSVCIPlanning Application Forms\ Page 3 of 3 Job No 2005-231 LLA1 <br /> Lot Line Adjusiment.doo.{Revised 6-4-04} <br />