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..�` APPLICATION - LOT LINE ADJUSTMENT <br /> i�ui�`r z<i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> FOR% FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> r <br /> NLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> he Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> ployees 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 /> 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 /> Robert A.and Justine B. Machado,Trustees of the R&J Machado Revocablp Trust Dated Sep m r12,2011; <br /> Print Name: Robert A. Machado,Trustee Signature: Date: 4z--Zzz <br /> Print Name: Justine B. Machado,Trustee Signature: <br /> David A. Machado and Juline M. Pacheco Machado,Trustees of the D&J Machado Revocable Trust Dated September 11, <br /> 2009 <br /> Print Name: David A. Machado,Trustee Signature:: )=,+` � �/1�4�,,�17�n�, Date: /L'/D -/Z <br /> Print Name: Juline M. Pacheco-Machado. Signatures. ,, � L�7Cl�eco/I'I 0.CV Date: /;L- <br /> Trustee U <br /> Print Name: Signature: Date: <br /> I <br /> F,1)EVSVC\P1anning Application Forms\ Page 3 of 3 Job No 2012-259 LLA.doc <br /> -oi Lmc Adjustmem.doe (Revised 64-04) <br />