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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �._ FILE NUMBER: <br /> \(iF ohm' <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 /> APN 055-140-12 and 055-150-07: Steve M. Coldani <br /> Print Name: Steve M. Coldani Signature: _ Date: <br /> APN 055-150-20: Barbara J. Coldani,Trustee of the Ray Coldani Credit Trust _ <br /> Print Name: Barbara J. Coldani,Trustee Signature: ' - � to e� �D <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F9DEVSVCIPlanning Apptiratim Fomsl Page 3 of 3 Job No 2013-221 LLA.doc <br /> Lot Line AdjustmentAm.(Revised 05-11-09) <br />