Laserfiche WebLink
r' <br /> APPLICATION -- L <br /> OT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE (NUMBER: <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 /> 1, 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 <br /> are true and correct. <br /> 1 <br /> Print Name: Ronald W. Marsh Signature: F . <br /> .eL36Date: <br /> Print Name: } <br /> Signature: Date: <br /> Print Name; <br /> Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> I <br /> F.MEVSVCWianning Application Forms\ Page 3 of 3 <br /> Lot Lme Adjustment.doc.(Revised 6-4-04) Job No 2005-68 LLA <br />