Laserfiche WebLink
''PLICATION - LOT L(�, ADJUSTMENT <br /> . SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �.. P FILE NUMBER: <br /> 4L�y6IV <br /> R I Ift <br /> -AUTHORIZATION SIGNATUlA V I V <br /> ONLY.THE OWNER OF'THE:PROPERTY OR AN AUTHORIZE© AGENT MAY FILE AN APPLICATION. ;:. <br /> 1; 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 /> ,l, 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 /> 'i are true and correct. <br /> Print Name: Marion M. Jensen Signature Date- <br /> Print Name: Sof ea M. l=ore Signature: Date: � /b_ O <br /> It <br /> Print Name: June N. Mills Signature: Date: G <br /> q <br /> Print Name: Signat Date: <br /> Print Name: Signature: Date: <br /> EI <br /> Ii <br /> y I <br /> f k06cad1062521win-doo11a_app pdf <br /> F1DEVSVOPIanning Appiicarlon ForrW Page 5 of 7 <br /> Lot Lino Adjusimtn3 doc.(Revised 6-4 04) <br />