Laserfiche WebLink
APPLICATION - LOT SINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �.�iroRa FILE NUMBER: <br /> 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 /> 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 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: ALLEN DALE SIPMA,TRUSTEE Signature: Ai,. hate: 7 0I rGJ <br /> d0 <br /> Print Name: JANIS ALETHA SIPMA TRUSTEE Signature, _ Date:77 <br /> -0S <br /> Print Name: ARTHUR SIPMA TRUSTEE Signature: Date:_ _p <br /> _ a <br /> Print Name: VIRGINIA SIPMA TRUSTEE Signature: ,,�W ' .J rr, Date: 7` <br /> Print Name: Signature: Date: <br /> i <br /> F,\DEVSVC1Planning Application Forms\ Page 3 of 3 Job No 200$-36 LLA#4.doc <br /> Lot Linc Adjustment.doc.(Revised 6-4-04) <br />