Laserfiche WebLink
LYt•..' r <br /> APPLICATION.- LOT LmE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> gaA "kC 14 i ` <br /> :�f S Ng =am .. <br /> �' �,� s s Asa- .+.4 `�54,=;3%r:g�8?::„�'=°8r�;a -, .> �:a:;d "":.,_.� ,a `•i�"a'_._`. "-f.?. -r.=ua!.�.rs; - Fe`°t . -� 2 [- i. ^�.. q <br /> ,arf 7 3??erInkt�r,om <br /> ., ?N X T ##,,,0WN9, 1OFT �t, w—!W 1, 1 I t i >C ► 1 TF 1'�f IL'fAJi ++f llP <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 /> Print Name:Greg JackSan Signature: Date: h 8/23/2-005- <br /> Print <br /> 3 7-005'Print Name: Ken Jackson Signature: ma�yy,, Date: <br /> Print Name:Mary Jackson Signature: 122 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> I <br /> I <br /> FADEVSMPlanning Application Forms\ Page 3 of 3 Jolt No 2005.163 <br /> /Lot line Adjustment.doe.(Revised 6.4.04) <br />