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APPLICATION - LOT LINE ADJUSTMENT <br /> r',, f ,t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUIt <br /> THORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE 7ener <br /> III, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its <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 property owner(owner includes partner, trustee, trustor, or corporate o <br /> involved in this application, or P officer) ofLegal agent (attach proof of the owner's consent to the application of the property's in <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Mary Jo Focha,Trustee, or his/her Successor(s)in Trust of the Mary Jo Focha Revocable Living Trust Dated July?3,2014 <br /> Print Name: Mary Jo Focha,Trustee Signature: ���/ fit Date:iz��-� <br /> rlw-ia <br /> r i u u Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> \DEVSVcmanning Application Forms\ Page 3 of 3 Job No 2017-60 LLA <br /> .at Line Adjustment.doc.(Revised 6-0-04) <br />