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r <br /> a y i !!! ,PPLICATION -- LOT ,.-,NE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT' <br /> II PILE NUMBER: <br />' <br /> is <br /> AUTHORIZATION SIGNATURES <br /> t <br /> 7F[ �ONLYE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENTMAYFILE 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 /> II � <br /> ® I Legal property own�:er (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> .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: LEEROY SMITH Signature: �� <br /> l <br /> Date: <br /> Print Name: AUDREY MARK VAN LEWEN Signature: ; �r <br /> II r Date:Ty�' <br /> Print Name: ROBERT A. NEEP SignatureC <br /> Date: - •-, '- <br /> Print Name: KIM T. NEEP .. Signature: f r Date: )- 41j <br /> is <br /> Print Name: Signature: <br /> Date: <br /> i. <br /> I; <br /> ii <br /> I <br /> F:MEVSVC\Pianning Application Forms% Page 3 of 3 Job No 2007-207 LLA <br /> Lot Line Adjusiment.doc.(Revised 6-4-04) <br /> i' <br /> i <br />