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,PPLICATION - LOT "SNE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. 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 /> 1, 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) j <br /> involved in this application, or 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 /> i <br /> Print Name: ANGELA D. ZAMBETTI Signature; -Date:11 <br /> 10� <br /> Print Name: ARTISTIDE B. POLINI Signature: D <br /> - � - <br /> ate: <br /> Print Name: CORA M. POLINI Signature: G� 1�/7/ 4 J� Date:_ - f <br /> Print Name: JEFFREY J. POLINI CO-TRUSTEE Signature✓ C— Date: 'G <br /> Print Name: PATRICE A. CHRISTENSEN, ' fes' _ ` <br /> CO-TRUSTEE `;/{ tv' <br /> Signatur : r t, � '� � Date: C( <br /> w <br /> p <br /> i <br /> r <br /> F:IDEVSVCSPianning Application Formsl Page 3 of 3 Job No 2009-12 LLA <br /> Lot Line Adjustment-doc.(Revised 6-4-04) <br />