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i <br /> APPLICATION -- LOT r` NE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> \mac <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> E 1, 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 /> 1, 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 /> E g Print Name: —K-imheriey J. Horner, Successor Trustee Signature: g , ,_ ` <br /> r <br /> Date: <br /> Print dame: Philip Martin IIISignature: �,NeC2 <br /> Print Name: Anne Margaret Martin Signature!-( ! yet. a ✓ T''i J <br /> Print Name: <br /> Signature: ti <br /> Print Name: Signature: Date: <br /> s <br /> FOFVSVC1Pianning Application FormM Page 3 of 3 Job No 2405-132 LLA2 <br /> Lot Line Adjustment.doc.(Revised 5-4-04) <br />