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r,. <br /> �APPLICATION - LOT ONE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t <br /> FILE NUMBER. <br /> CQL1FCiRa`P <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 penaltyy 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 /> F-1Legalagent (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: Paul Lundblad Signature: V Date: 5-16 —0 b <br /> Print Name: Signature: Date: <br /> Print Name: { Signature: Date: <br /> Print Name: {{[ Signature: Date: <br /> Print Name: t Signature: Date: <br /> I <br /> a <br /> i <br /> a <br /> F:IDEVSVC\Planning Application Formsl Page 3 of 3 Job No 2005-293 LLA <br /> Lot Line Adjustment,doc.(Revised 6-4-04) <br /> r <br />