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APPLICATION - LOT LINE ADJUSTMENT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 706r, FILE NUMBER: <br /> d <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 County arising from 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 /> APN 249-110-18, Elmo O.and Ardythe E.Ward,Trustees of the Elmo O.and Ardythe E.Ward Revocable Trust, established <br /> May 14, 1987; <br /> Print Name: Elmo O.Ward.Trustee Signature: p /J A Date:lU. A5, /Z <br /> Print Name: Ardythe E. Ward,Trustee Signature: 1� b 1,[f d /YZZI l� Date:/U z.S,/Z <br /> APN 249-110-61, Robert C.Smith,Sr.and Laura L.Smith,Trustees f the R &L Revocable Trust Under Instrument Dated <br /> January 11,2007 <br /> Print Name: Robert C.Smith,Trustee Signature: y,��,(,/ Date: /0--Z.3- )-Z <br /> Print Name: Laura L.Smith,Trustee Signature: Date: X/ -/ <br /> Print Name: Signature: t, Date: <br /> F:IDEVSVC0anning Application Fonns\ Page 3 of 3 Job No 2012-223 Lot Line Adjustment.doc <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />