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APPLICATION LOT LINE ADJUSTMAF <br /> ENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT PMENT DEPARTMENT <br /> i <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, hold <br /> employees from any claim, action or proceeding against t the Owner/Agent's projecss the Countt and its agents, officers and <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 and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> I <br /> Print Name: ED MACHADO Signature: <br /> Print Name: Dater— ZZ_ sre <br /> Signature: Date: i <br /> Print Name: Signature; <br /> Date: <br /> Print Name: Signature: i <br /> Date: <br /> Print Name: <br /> Signature; i <br /> Date: <br /> ii <br /> f <br /> I <br /> F IDEvsvC\Plann;rig Application Forms\ Page 3 of 3 <br /> Lal Line Ad)ustment.doc.(Revised 6-4-04) Job No 2007-223 LLA-doc <br />