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APPLICATION - LOT LINE ADJUSTMENT <br /> ` < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �Yic pN'o FILE NUMBER: <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 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 /> San Bernabe Vineyards, LLC <br /> Print Name: Signature: Date: <br /> Delicato Vineyards <br /> Print Name: Signature: Date: <br /> South San Joaquin Irrigation District ,�/�� <br /> Print Name. Signature: TY�L`[,a Date: <br /> F TEVSVC1P1annmg Apphw on Forms- Page 3 of 3 Job No 2016-269 LLA-2 <br /> Lot line AdlusCnent doc.(Revised 08-71-05) <br />