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APPLICATION - LOT LINE ADJUSTMENT <br /> y ,,may 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. <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 County arising from 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 /> APN 065-100-08: <br /> Paul A. Lundblad and Carl Lundblad J _ <br /> I, <br /> Print Name: Paul A. Lundblad Signature: � /� •1'�— Date: <br /> Print Name: Carl Lundblad Signature: ry " Date: <br /> APN 065-100-29 and 30: <br /> Amy Lundblad,as trustee(or the successor trustee)of the Amy Lundblad Trust,as amended and restated in 199,as <br /> amended on April 27,2001 <br /> Print Name: Amy Lundblad,Trustee Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVMPlanning Application Fonnsl Page 3 of 3 Job No 2012-79 Lot Line Adjustment,doc <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />