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q4�t APPLICATION - LOT LINE ADJUSTMENT <br /> w SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •.- FILE NUMBER: <br /> �c�)k• .a�•. <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY 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 /> ® 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 /> Rene Ann Coburn,Trustee of the Rene Ann Coburn Revocable t Uncle mber 81199T <br /> Print Name: Rene Ann Coburn,Trustee Signature: Dat . 1,511 <br /> Print Name: Signa Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSMPlanning Application Fonnsl Page 3 of 3 Job No 2017-48 LLA <br /> Lot Line Adjustment.doc.(Revised 8-4-04) <br />