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APPLICATION -- LOT�LINE ADJUSTMENT <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> o4Cf—P 6w FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> -ONLY THE OWNER..OF THE PROPERTY OR<<AN AUTHORIZE©,`AGENT MAY (FILE AN.APPLICATION: <br /> 1, 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 4 <br /> are true and correct. <br /> Print Name: ED MACHADO FOR CIRCLE JM DAIRY Signature: Date: 2- — 6 <br /> Print Name: ED MACHADO, <br /> FOR CIRCLE JM PROPERTIES LLC Signature: Date:_, 4►—� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> FIDLVSVC\Planning Application Forms\ Page 3 of 3 Job No 2007-230 LLA.doc <br /> Lot Line Adjustment.doc.(Revised 6-4-04) 6"H LLA <br />