Laserfiche WebLink
APPLICATION ® LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "�.. . . FILE 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 /> I, 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 and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. / <br /> Print Name: k GM XA-N �AAr� � <br /> Signature: /T� �� Date: <br /> Print Name: x /C K 40.4�� Signature: Date: <br /> Print Name: X fTN/YG.LCM tZ- LK O ti,�fSSignature: Date: <br /> Print Name: )(���fL�ES J22965E Signature: Date: /N 11L <br /> Print Name: X f2 r i&4 )97 t5ekl C Signature: _�L ..-iw WLu .oma Date: —/ <br /> �ft�R��A-r"t-f�,�sE 9��.G.�z9�� �-►�.- r;� <br /> Ste'�j�� QOeI/11i� f/ <br /> F:oEvsvoPianning Application Forms\ Page 5 of 7 <br /> Lot Line Adjulrnent.dcc.(Revised 64-04) <br />