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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> r1employees <br /> the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> 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 officer) of the property(s) <br /> invoived in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involve <br /> application and have been authorized to file on their behalf., and that the foregoing applica oln statements <br /> n this <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 23, 2014 <br /> Print Name: Mary Jo Focha. Trustee Signature: 1 <br /> �✓ �d Date: l <br /> i i ilt!4'aiTie: Signature: <br /> Date' <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> '9DEVSVC1PIanning Application Formsi Page 3 of 3 Job No 2017-60 LLA <br /> .ot Line Adjustment.doc.(Revised 64-04) <br />