Laserfiche WebLink
APPLICATION - DEVIATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER DV - <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 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 />APN 228-110-01 <br />Dale A. Van Groningen and Patricia J. Van Groningen, Trustee of the D&P Van Groningen Family Trust UTA/D 1114106, as <br />Amended; <br />Print Name: Dale A. Van Groningen, Signature:) 14 //a. -` Date: <br />Trustee i <br />Print Name: Patricia J. Van Groningen, Signature: Date: <br />Trustee <br />APN 228-080.10 <br />Dale A. Van Groningen and Patricia J. Van Groningen, Trustee of the D&P Van Groningen Family Trust UTA/D 1114108, as <br />Amended; <br />Print Name: Dale A. Van Groningen Signature: An, Date: <br />Trustee <br />Print Name: Patricia J. Van Groningen Signature ate: <br />Trustee <br />Daryl Kent Van Groningen and Arlys F. Van Groningen, Trustees of the Daryl Kent and Arlys Van Groningen Family Trust, <br />U/AID 7111107, as Amended; <br />Print Name: Daryl Kent Van Groningen, Signature: Date: <br />Trustee <br />Print Name: Arlys F. Van Groningen Signature: Date ': <br />Trustee t. <br />Henry Mark Van Groningen and Debra Van Groningen, Trustees of the H.M. & D.L. Van Groningen Family Trust, UTA/D <br />September 26, 2007, as Amended <br />Print Name: Henry Mark Van Groningen, Signature 1�J by <br />Trustee <br />Print Name: Debra Van Groningen, Signature: fk Date: ilvllaz <br />Trustee <br />F:\DEVSVC\Planning Application Forms\Deviation doc. (Revised 5-11-n9) Page 3 of 3 2018-117 Deviation <br />