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APPLICATION - LOT LINE ADJUSTMENT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �•. ;t FILE NUMBER: <br /> 9LrF0 RM <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 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 /> Print Name: JAMES E. BOERSMA Signature: Date:o� 07 <br /> TOMMIJO BOERSMA e <br /> Print Name: Signatu ��u ' CtAcmc- Date:=�2�e� <br /> Print Name: JULIE C. BOERSMA Signature: Date: . <br /> Print Name: RICHARD KAMPER Signatu Date:,� <br /> Print Name: BRENDA C. KAMPER Signature: 2 z 7-1 A <br /> F:\DEMSMCPanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />