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c° .APPLICATION — LOT LINE ADJUSTMENT <br /> N- SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c4c;x iW' • FILE NUMBER: <br /> " AUT <br /> O RIZATI'O N,;S I G NAT,U:RES <br /> Femployees <br /> E;OWNER OF:THE PROPERT>Y OR AN AUTHORIZED AGENT,,MAY:FILE AN APPLICATION. <br /> r/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Z 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: ED MACHADO FOR CIRCLE JM DAIRY Signature: <br /> Date:- / <br /> Print Name: ED MACHADO, <br /> FOR CIRCLE JM PROPERTIES LLC Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I` <br /> I <br /> RTEVSVCIPIanning Application Formsl Page 3 of 3 Job No 2007-231 LLA.doc <br /> Lot Line Adjustment.doc.(Revised 6-4-04) 9r"LLA <br />