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°1rPPLICATIQN - LQT LAE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 'ilia, ., <br /> FILE NUMBER: <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one).- <br /> Legal <br /> ne):Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the propert s <br /> involved in this application, or Y( ) <br /> ❑ i <br /> Legal agent (attach proof of the owner's consent to the application of the property's involved n this <br /> application and have been authorized to file on their behalf., and that the foregoing applicatio <br /> are true and correct. n statements <br /> Print Name: Manuel Peter Vieira Trustee Signature: ' �X f/41 <br /> ✓_ Date: / <br /> Print Name: Manuei Peter Vieira Trustee Signature: <br /> -�(� Date:_ <br /> Print Name: Diane Maraccini Signature: `q�Q�, <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> F:TEVSVC\PIanning Application Formsl Page 3 of 3 <br /> LotLineAdjustment.doc, (Revised 6-4-04) Job No 2007-33 LLA <br />