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d <br /> 34 1 <br /> Ar'PLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c P <br /> FILE NUMBER: <br /> Q�i's a R`a <br /> AUTHORIZATION SIGNATU RES <br /> ONLY THE OWNER;OF,THE�'PRO,PERTY 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 /> El 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: Wlndwood Estates Signature: Date: Z D <br /> fl <br /> r <br /> Print Name: Robert Beckham Signature: Date: Z_ . 06 <br /> Print Name: Len Casanega aSi ,e�,:� Date: , <br /> Print Name: <br /> Kelly/Janet Nlmtz (/ i hn r Date:- �� D <br /> Print Name: Signatur Date: <br /> FMEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-G4) <br />