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I �N: , d. ,r-rPPLICAT ON — LOT LINESAN JOAQUIN COUNTY COMMUNE AD ADJUSTMENT <br /> • �A DEVELOPMENT DEPARTMENT <br /> FILE NUMBER. <br /> I <br /> 12 <br /> AUTHORIZATION SLGNATURES. <br /> ONLY THE OWN <br /> ER,OF THE PROPERTY OR AN.AUTHQRIZED AGENT M1Y FILE AN <br /> PLICATION: <br /> ! the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents officer <br /> employees from any clam, action or proceeding against the Owner/Agent's project. sand <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 <br /> involved in this application, or ) of the property(s) <br /> Q Legal agent (attach proof of the owner's consent to the application of the property's <br /> 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: ED MACHADO FOR CIRCLE JM DAIRY Signature: 01F,111110 <br /> `` <br /> Dater(o— Z� <br /> Print Name: ED MACHADO, <br /> FOR CIRCLE JM PROPERTIES LLC Signature; <br /> 1; Date: <br /> 2- 1 <br /> Print Name: Signature: <br /> Date: <br /> Print Name; Signature, <br /> Date: <br /> Print Name: Signature; <br /> Date: <br /> I <br /> ' I <br /> F:IDEVSVC\Planning Apoication Forms\ Page 3 of 3 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) Job No 2007-226 LLA.doc <br /> 4'"LLA + <br />