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oggUIN <br /> — `c° APPLICATION — LOT LINE ADJUSTMENT <br /> rZ -� <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \ <br /> c dg1FILE NUMBER: <br /> ''/ <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN A17project. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agen <br /> employees from any claim, action or proceeding against the County arising from the Owner/AgI, 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 p <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 /> Patricia W.Sitkin,Trustee of the Elmer D. and Patricia W. Sitkin Survivor's Trust; Patricia W.Sitkin,Trustee of the Elmer D. <br /> and Patricia W.Sitkin Exemption Trust; Patricia W.Sitkin y .t.. <br /> Print Name: Patricia W. Sitkin, Trustee Signature: 11�i I,SLI,�.I Cy, IA�,6 vl �Lt,,,� Date: L iGr� S <br /> Masami C. Sitkin, Trustee of the David A.and Masami C.Sitkin 2005 Trust Under Agreement Dated December 13,2005 <br /> B <br /> Print Name: Masami C. Sitkin,Trustee Signature: .-/i,_{�,,&nt G � .��-�.,_,. Date: ���Z <br /> Roger Sitkin, Trustee of the Roger Sitkin Living Trust of July 31, 2012 <br /> Y <br /> Print Name: Roger Sitkin,Trustee Signature: ,/`":.,- ——� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMPlanning Application Fonns\ Page 3 of 3 Job No 2015-195 LLA <br /> Lot Line Adjustrnent.doc.(Revised 05-11-09) <br />