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,.4-. - LOT LINE -ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZAT <br /> 1W SIGNATURES j <br /> €' ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APP <br /> LICATIONi. <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 /> E <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 /> are true and correct. <br /> Print Name: Signature: ' -- <br /> Filios Properties, LL �-- <br /> Print Name: Donald Myron Shiple Date:_ <br /> ' _ <br /> Signature: <br /> Date:_:-' <br /> Print Name: Kelly Lee Shi le <br /> Signature: Y `� <br /> �-��-��' Date: <br /> Print Name: ! <br /> Signature: Date: <br /> FIDEVSMPianning Application Forms4 Page 3 of 3 5 <br /> Lot Line Adjustment.doc(Revised 6-4-04) Job No 2007-92 LLA.doc <br /> EJ <br />