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�O.• ' C\ <br /> • , Y=` APPLICATION -- LOT SINE ADJUSTMENT <br /> T <br /> I ' X} SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> xH b <br /> .� <br /> ONLY THE;QVVNER OF`T <br /> qA <br /> THE PROWI '1(> R,AN AIi { Rf L <br /> - � ZEd ACEIWT;IIIIAY>FtLE AN AI3pLICa4TIQN. <br /> I, the Owner/Agent agree, �to defend, indemnify, and hold harmless the County and its agents, <br /> employees from any claim, action or proceeding against the Owner/Agent's project. officers and <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ) <br /> ® Legal property owner (owner includes partner, trustee trustor, <br /> or corporate officer <br /> involved in this application, or ) of the property(s) <br /> ❑ Legal agent (attach pro 6 f of the owner's consent to the application of <br /> the rt 's involved in this <br /> application and have been authorized,to file on their behalf., and that the fore ing application statements <br /> are true and correct, <br /> Print Name: Julio Feri Trustee <br /> Signature: a D <br /> ate; _ <br /> Pant Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> i <br /> I <br /> F:QEVSVC\Plannin A For <br /> 9 Application np mS\ Page 3 of 3 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) Job No 2005-231 LLA2 <br />