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;: .APPLICATION - LOTS INE ADJUSTMENT <br /> x <br /> i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4ti`clRc�` FILE NUMBER: <br /> I AUTHORIZATION SIGNATURES <br /> FONLY THE OWNER OF.THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> , e 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 pro if of the owner's consent to the application of the property's <br /> n 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: Mark Lewallen Signature: tate: 2 <br /> Print Name: Bonner W. Mendez <br /> Al 11 <br /> Signature: .6e,"Aw c�P '°' ' Date:24;4t <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: ! <br /> Print Name: Signature: Date: <br /> I <br /> i <br /> II <br /> 1 <br /> I <br /> I <br /> I <br /> i <br /> I <br /> F:0EVSVMP1anning Appl�cation Formsl Page 3 of 3 Job No 2005-247 <br /> Lot Line Adjustment,doc.(Revised 6-4-04) <br />