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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \c._ FILE NUMBER: <br /> is%,/ <br /> I <br /> AUTfO [zAT�oN 'SGtV�IT� iEs <br /> i <br /> 77 <br /> ONLY THE OWNER GF? THE�F'PAOPERTY-,, ;4N AIJTFIORIZED,AG 1 NT;MAY FIDE"AN`APPLICATION. <br /> I <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 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 /> i <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 /> I Mario Jaques as Trustee of the Mario Jaques Separate Property Trust dated September 15,2008 <br /> I <br /> Print Name: Mario Ja_gues,Trustee _ Signature: Date: _ ( -- 1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> [Print Name: Signature: Date: <br /> I <br /> F`,DEVSVCIPIanning Application Formsl Page 3 of 3 Job No 201 1-28 Lot Line Adjustment.doc <br /> Loi Line Adjustmentdoc. (Revised 6-4-04) <br />