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6 � <br /> °ter° `-APPLICATION LOTfdNE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> r y <br /> ' g EL{■ ^'(��}',/(� x � ,y77 <br /> .a. }ei �'2,t }r.-. . -u <br /> '3+ - k ' j A� � <br /> � �� � N <br /> ,�:;.'� .7,7.,_. x s� 3�°:`� 2,-tl <br /> O�RY7HE flWN.F�t��'F`H�,iE�l�4���'Y,��R . .l,.�1�►.�,���fC� �©,� rNTi: �Y��� y4PWtiC�A�'[ONSy,s',: <br />` I, 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 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 /> Print Name: Ralph Ruiz,Trustee Signature: Date: <br /> Print Name: Dorothy Ruiz Trustee Signature: U-"7, _ 1 n Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> I <br /> I <br /> I <br /> i <br /> F:IDEVSVC1Planning Application Forms Page 3 of 3 ,fob No. 2004-217 i <br /> Lot Line Adjustment.doc. (Revised 6-4-04) <br /> i <br />