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k.'PLICATION -- LOT L,JE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> it <br /> oiii�� Ip FILE NUMBER: <br /> ,Al`€ '� AUTI` �3� 14TlNA `IRS � � <br /> �� h " ��'� E ✓� �,« 1" 8 � fK� d 'ba �JL3�=iH i�ty.„..P...,. tt�'� [y ;� <br /> �o : ����►�ac�r�Nl� vl�:��rlr�� .l�c����r.�rR�a��r�a��z�� _�I��e . _����:�c��rllol� <br /> SIL <br /> I,'the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from ariy cia,im, action or proceeding against the OwnerlAgent'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.appliication, 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:M <br /> ie f <br /> Print Name: Thomas Gassner Signature Date: <br /> Print Name: Geor ene Gassnernature. <br /> : <br /> Si <br /> 9 Date: <br /> Print Name: I� <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Lntame: !I Signature: Date: i <br /> !i. <br /> I� <br /> �i <br /> i <br /> 1� <br /> it <br /> it <br /> l <br /> a <br /> j� <br /> 'I <br /> I� <br /> i <br /> �I <br /> FADEVSVC�Planning Applicatiori Farmslr Page 3 of 3 Sob NO 2004-239 <br /> Lot Line Adiustmentdoc.(Revised 6-4-04) <br /> i <br />