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AIr PLtCAT ON - LOT UNE ADJUSTMENT <br /> SAN JOAQUlN,000NTY COMMUNITY DEVELOPMENT D `PARTMi=NT <br /> iii:..••' FILE NUMB>;R:. <br /> i <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN.AUTHORIZED.AGENT MAY.FILE AN APPLICATION. F <br /> I�, the.Owner/Agent agree to defend; indemni <br /> fy, and hold harmless the County and its agents, officers and <br /> erriployees from any claim, action or proceeding againsf1h�e Owner/Agent's-project: <br /> ...I, further, certify under penalty of perjury that'l am {check one): <br /> 0 Legal property owner.{owner includes partner, trustee, trustor, or cor orate officer of the ro e s <br /> ".involved in:.this.app.ica#i!on; or ,.:. <br /> P ) p p rty( ) <br /> ❑ Lega! agent (attach:proof of the owners;consent to the a lication.of the ro e <br /> pp . p p rty's involved in this <br /> application and have been authorized:to file oh their behalf;; and that the foregoing application statements.. <br /> aro true.and correct. <br /> Print Naive THOMAS R FLINN Signature: <br /> Date. <br /> Print Name. KEVIN ALBERG <br /> Signature: X <br /> Date. <br /> Print Name <br /> . .. Signature; O� <br /> Pant Heine Si nature <br /> 9 <br /> Print Name <br /> Signature: <br /> W. <br /> D2�te. <br /> i <br /> FADEVSVCkPfanning Appr,cation Fonnsl DATE:APRIL 1,2005 <br /> LgtUneAdjustrient.doc.(Revised 6-4.04) <br />