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AriPLICATION LOT L114E ADJUSTMENT <br /> 1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> RUTH©R1 4TIQN 51C, Vr4TUF <br /> ONLY THE OWNER,OF SHE PR TY'pp <br /> OPE� AN AUTHt]R1ZE,© ��ENT'1VIAY FfLE N'APPLfCAT <br /> l the QwN. <br /> ner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers Oan <br /> employees from any claire, action or proceeding against the Owner/Agent's r d <br /> 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) <br /> involved in this application, or er) of the property(s) <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: Jose hine Alexander Signature: <br /> Print Name: <br /> Date: o <br /> Signature: � <br /> Print Name: Date: <br /> Signature: k <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature: Date: <br /> a <br /> I <br /> FADEVSVcTianning Application Forms` <br /> Lot Line Adjustmentdoc.(Revised 6-4-04) Page of 3 <br /> Job No 2005-167 <br /> r <br />