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PCU`" ° "APPLICATION - LOT LINE ADJUSTMENT <br /> a.... <br /> Q SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> q\\\ciFoaN. <br /> AUTHORIZATION'SIGN;ATURES <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 employees <br /> 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) involved in <br /> X <br /> this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> El and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print �y c-' <br /> Name: Monty A.Vander Beek,Trustee signature: �Mr a1X 1— Date: C <br /> Print �. <br /> Name: Karen J. Vander Beek, Trustee signature: _ ( J Date: <br /> Print <br /> Name: Jerry M. Vander Beek,Trustee Date: 32zG <br /> Signature: zvi ; �j Sly <br /> Print .f.) 7 <br /> Name: Patricia M. Vander Beek,Trustee Signature: Tu 43 �y ;d'X. y yr�lc r�C1Esx�_ Date: ? �?— <br /> Print <br /> Name: Signature: Date: <br /> F:DEVSVC/Planning Application Forms/ <br /> Lot Line Adjustment doc. (Revised 06-04-04) Page 3 of 3 Job No 2004-66 <br />