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PLIC <br /> PAP ATION -- LOT Li <br /> NENE ADJUSTMENT <br /> 1 . ! Y,. 1 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 APPLICAT <br /> ION. <br /> i 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, offi <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> f <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 involved in this application, or yi <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> El Legal agent (attach proof of the owner's consent to the application of the property's involved i <br /> 11 <br /> are true and correct. <br /> LName: <br /> Barbara A. Martinsen <br /> Signature: er�¢�,e� Dater G 7 <br /> t <br /> Signature: I. <br /> Date: <br /> Signature: <br /> Date: <br /> Signa#ure: <br /> Date: <br /> i <br /> Signature: Date: <br /> f <br /> 1 <br /> t <br /> F:\DEVSVCip1annirg APPliCation Formsl <br /> Lot Line Adjustment.doc.(Revised 6-4-04) Page 3 Of 3 Job No 2005-294 LLA <br />