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%. <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> in_ ti <br /> FILE NUMBER:I . o,). <br /> I <br /> AUTHORIZATION SIGNA7theproperty's <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZEAY FILrinthis CATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmlety andfficers and <br /> employees from any claim, action or proceeding against the Counm the Oproject. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> © Legal property owner(owner includes partner, trustee, trustor, officerrty(s) <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owners consent to the applicaropertythis <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> =NameSignabure: <br /> SOLARIO Signature Date: 10 ' 3 <br /> K BELLINO Signature: DaterS�7 <br /> Y BELLINO Signature Date) J �3 <br /> Signature: Date:Signature: Date:---- <br /> F MEVSVC91anninq <br /> ate ___F:MEVSVC91anninq Aookation Formsl Page 5 of 7 <br /> Lot Line AdjUs Om LdM (Revised 05-11-09) <br />