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q ;ry APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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 /> Robert L. and Cynthia Pombo,Co-Trustees of the Robert and Cynthia Pombo Revocable Trust, Dated June 27, 1992 <br /> Print Name: Robert L. Pombo.Co-Trustee Signature: Date: ti Q(—j 3—r Q <br /> Print Name: Cynthia Pombo.Co-Trustee Signature: JOD Date: IZr13'Iy <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FZEVSVCT1anntng Application Fomsk Page 3 of 3 .lob No 2011-177 LLA.doc <br /> Lot Line Adjustmerrtdoc.(Revised 05-11-09) <br />