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P Q U <br /> .�PPLICA <br /> x. TION - LOT <br /> &-INE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �•� -gip ;� I <br /> FILE NUMBER.- <br /> AUTHORIZATION <br /> UMBER:AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 /> 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) <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: A ollonia DePalma Trustee Signature: <br /> Date: <br /> Print Name: A ollonia DePalma Trustee Signature: <br /> ate: <br /> Print Name: k t3-a-,;Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> ,. Date: <br /> I <br /> i <br /> I <br /> I' <br /> FIDEVSVC\Pianning Application Forms\ Page 3 of 3 <br /> Lot Line Adjustment_doc.(Revised 6-4-04) Job No 2006-213 LLA <br />