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<br /> tip APPLICATION - LOT LINE ADJUSTMENT
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<br /> N < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT
<br /> • as���. � FILE_ NUMBER:
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<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 /> ❑ Legal agent(attach proof of the owners 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 /> Date Exocuted: A99—
<br /> _,2014 Aatc Exeouted2074
<br /> Edwin Gillctte(Tnist# E&J Gillette Living Trust
<br /> By By
<br /> Apr-1 4ille tutee Apri . Gille e,
<br /> Date Executed: 1 Y ,2014 Date Executed: ,2014
<br /> Park S.Crcrald Remainder Tntst Chapin Trust No. One
<br /> By - By
<br /> Marie G. Gerald,Co-Trustee Charles Chapin,Co-Ifustoo
<br /> By By _
<br /> Marie Gerald McNeal,Co-Trustee Carol Chapin Humes,Co-Trustee
<br /> Date Executed: ,2014 Date Executed: _ 12014
<br /> Howard A. Will Grantor Twist
<br /> Marie C,crald McNeal
<br /> By -
<br /> Howard.A.Will,Tr.,,'Ii•u.stee
<br /> ])ate Executed: ,2014
<br /> Date Executed: ,2014
<br /> Anne Gerald Bachman —
<br /> Wendelin F.Will
<br /> Date Executed: ,2014
<br /> _Clifton Park Gerald _
<br /> F:toEvsvaizlennfng Application�Forms\ Page 3 of 4 Job No 2013-235 Lot Line Adjustment.doc
<br /> --AAl—tr PP t A'Ael IRAVISPI1a6-4-04I
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