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W <br /> APPLICATION - LOT LANE ADJUSTMENT <br /> is <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> M �4i, <br /> ' "T <br /> AIR-11A- <br /> 0 <br /> E "y <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> 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 /> X <br /> Legal property owner (owner includes partner, trustee, trustor or corporate officer) of the property(s) involved in <br /> this application, or <br /> E] Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> and have been authorized to file on their behalf andthat the foregoing application statements are true and <br /> correct. <br /> Print <br /> Name: Randy R.Grimm Signature: X- Date: <br /> ate: <br /> Name: Janna B.Grimm Signature: <br /> )naturet2t Date: <br /> Print <br /> 't <br /> Name: Willard R. Rieger,Trustee Signature: <br /> Print Date: 0 <br /> Name: Frankie B. Rieger,Trustee Signature, <br /> Print <br /> Date:Z42 4P -405-1, <br /> Name: <br /> Signature: Date: <br /> F:DEVSVC/Planning Application Forms/ <br /> Lot Line Adjustment doo. (Revised 06-04-04) Page 3 of 3 Job No 2004-136 <br />