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r , <br /> 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 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 063-150-58 <br /> Kathleen A.Powers,Trustee of the Powers Family Trust dated March 27,2009;Shelley Nies Ross;Elizabeth Nies Stein! <br /> Print Name: Kathleen A.Powers,Trustee Signature: '-6a�e: 1Z)17 <br /> Print Name: Shelley Nies Ross Signature: Date:r��� <br /> Print Name: Elizabeth Nies Stein Signature: Date: <br /> -,& <br /> 063.150.64 and 65 <br /> Kathy Nies Powers and Shelley Nies Ross as Co-Trustees of the Marvin Nies 2012 Trust <br /> Print Name: Kathy Nies Powers,Co-Trustee Signature. L i� O Date: <br /> —A) 7 <br /> Print Name: Shelley Nies Ross,Co-Trustee Signature: / Date: <br /> F:\DEVSMPlanning Application Forms\ Page 3 of 3 Job No 2016-05 LLA <br /> Lot Line Adjustment.doc.(Revised 6-4-64) <br />