Laserfiche WebLink
APPLICATION _ LOT LINE A <br /> DJUSTMENT <br /> l,. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN gUTHpRtZED AGENT MAY FILE AN APpLI <br /> N. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents Officers <br /> a <br /> employees from any claim, action or proceeding against the Owner/Agent,s p �� and <br /> I, further, cert. roject. <br /> certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer <br /> involved in this application, or ) of the property(s) <br /> ❑ Legal agent (attach proof of the owner's <br /> application and have been authorized consent to the application of the p <br /> are true and correct. ��to file on their behalf., and that the fos involved in this <br /> eg ng application statements <br /> Print ; G E12 7 UAI C,,P <br /> l/ ,�t,,L, <br /> Print Name: Signature- Date: 7 - 4-07 <br /> Print Name: Signature: -- <br /> Date: <br /> Signature: ------- <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Date: <br /> .-0EVSvVI <br /> A Page 5 of 7 <br /> N I�gry,y�f tor, R'MX-1 <br />