Laserfiche WebLink
APPLICATION - LOT LIME ADJUSTMENT <br /> �� { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •c�..• ;P• FILE NUMBER: <br /> iiFoi+ei <br /> AUTHORIZATION SIGNATURES <br /> "ONLY THE OWNER.OF.THE PROPERTY OR'AN'AUTHORIZED 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 1 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 applico,6n of the property's involved in this <br /> application and have been authorized to file on their beha , and that the foregoing application statements <br /> are true and correct. <br /> Print Name: 0EL.TA FAUC 10(i Cont PRS ysjgnature: /bra Date: 18 D$ <br /> Print Name: Lob I 04C ' Signature: RN IE COST MAG W Al Date. <br /> $l JU <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVC1P1ann1ng Application Fmms1 Page 5 of 7 <br /> Lot Line Adjustmerd.doc.(Remised 5-4.04) <br />