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a <br /> T LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t <br /> AttxF1ORI�ATION SIGNANIt = <br /> i ;;., � _, ..: ,:, ONL.YTIfL�S'VN�RtIf� P'Flf]I�TY R1s(YAf1THChld2E131�3�1i1AYFld�IlN.11ldAf�AT7C�1� .,....,� <br /> I,the OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any clalm,action or <br /> proceeding against the OwnwYAgent's project <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> 41 Legal property owner(owner includes partner,trustee,trustor,or corporate aMeeo of the property(s)Involved In this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the appllcatlon of the propertyt Involved In this appllcadon and have <br /> been authortted to file on their behaK.,and that the foregoing application statements are true and correct <br /> 4 <br /> Print Name: 1 OLb Signature: i Date: <br /> Print Name:lcizz tGT IrvysST/hfvrs Signature: Date: <br /> Print Name: ��,c� Signature: Date: <br /> / <br /> Print Name: �Ca .�-t `p_. Signature: Date: <br /> Print Name: , y Signature, Date: <br /> EUGENE & LAUREEN CASALE LOUIS & DALE CASALE <br /> 4947 N. JACK TONE ROAD 4935 N. JACK TONE ROAD <br /> STOCKTON, CA 95215 STOCKTON, CA 95215 <br /> I (209) 931 -6337 ( 209 ) 957-3133 <br /> E <br /> E <br /> I <br /> A <br /> f <br /> r <br />{ 10..W N PkLA06•*Wuwy 1.1M <br />