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= Air..e'LICATION -- LOT L114" ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ":AUTHORVATION SIGNATURES,>' <br /> ONLY-THE OWNER OF,THE PROPERTY OR AN AUTHORIZED i4t;3ENT 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 /> I <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 at'rthor¢ed to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: G Signature: Date: <br /> Print Name: Signature: Peter T. Zeiter Date: <br /> Print Name: t signature: Herb Keener <br /> g Date:_ 14—oG <br /> Print Name: + Signature: ShirleyKeener Date: <br /> Print Name: ± Signature: Date: <br /> FIDEVSMPtervirp Application Forms% Page rJ of 7 <br /> Lot Une A4u*mk.doo.(Revised 6404) <br />