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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> i <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 /> ) <br /> Pnnt Name: Nancy LoBello Signature- rj�o Date: l ' >/ <br /> Pnnt Name: Albert Due Signature: - i Date: <br /> Pnnt Name: Carol LaRosa Sgnatu e: 24Lftda,171, Date: <br /> Print Name: Lam Due Signature: Data: M' <br /> i r t 2_ <br /> Pnnt Name: Signature: Date: <br /> F\DEVS=Ranning Application Forms\ Page 3 of 3 Job No 2012-156 Lot Line Adjustment.doc <br /> 'Lot Line Adjustment.doc(Revised 05-11-09) <br />