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A. PLICATION — LOT LI t ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> f <br /> I <br /> .; " Al 'HQR1 A�lO1 S[G TU1,RIE 7 rz « d <br /> ` _ <br /> :ONLY.THE OWNER OF THE PROPERTY 3R A1d,""11TH', RIt AO.ENT�kiAY� ILE,AN APPL`'ICATIQI�I <br /> 1,-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 /> I <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: Arnaudo Bros. Inc. Signature: Date: <br /> II �/ i <br /> Print Name: ��GGW,4--Vd gY'WAU W&Signature: CI�S <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />` Page 3 of 3 Job No 2005-09 <br /> F:�DEVSVC�Planning Application Forms g <br /> Lot Line Adiustment.doc.(Revised 6-4-04) <br />