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w +� <br /> Agt APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .. .P FILE NUMBER: <br /> 'q�rFOR�' <br /> ng mdr # c -3 i 3 e'd`35T- '33:7iS'Ss t '�S <br /> 3 b RUTH RI7 1T ON N TUF E y; .- <br /> S1G AE <br /> ., §7 <br /> . r-tta. : SH .r'.•.w rk ,!r �iPt _w. ';,�.y-mx <br /> ,k �i,,,y.. <br /> .ra,. r3y11' tl a[ € 2 E- 4 ] _ ri: <br /> ONLY TH ,OWNI ,R;OF TIDE PROPERTY Q,R�#I xA14W`—RIZE,D�AGF[ aT�MA f F,ILF AI�,;APIPL CATION <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 /> i <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 /> Addink Turf Farms, Inc.,A California Corp. " <br /> Print Name: Joel W.Addink—Treasurer— Signature: rw . Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I� <br /> I <br /> F:%DEVSVCTlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-3-03) <br />