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17/03/2913 09:48 2694651303 PHIL OCON ELL GRAIN PAGE 01/01 <br /> 12/03/2013 07:47 19168177144 PAGE e5 <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN dOAQU1N COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ~ FILF NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE O"GR OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwnertAgent agree. to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, aetlon or proceedrg against the County arising from the OwrieNAgent's project. <br /> t, further, certify under penalty of perjury that I am (check one): <br /> Legal prop"owner(owner irwiude .partner,trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> ❑ t egal agent (attach proof of the owner's consent to the appdcation of the property's involved to thm <br /> application and have been authorized to file on their behalf., and that the foregoing applimition statements <br /> are true and coned. <br /> Print IVrmo: A7Mtit. ET_ CA/WIW S)gnaturer: Drag: �3j <br /> Pr1n1 Name' y. !TI"6y1S $ipn9lurR: -(? <br /> DIME: <br /> Print Namn: S"tur9: r%AQ;—Le it 23 <br /> Print Namr. - sjwattxe- D91e: <br /> PrirR Ntmre: <br /> F:10EVSVCV%6nr"Amelxra rand ape 5 of 7 <br /> LO Line Adluw,,*iLdm M1,01mA dst 1_aal <br />