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4 „ <br /> r <br /> E? <br /> LOT UNE ADJUSTMENT <br /> SAN OA UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> y;�yp�».� -.. -¢..4�� ..°y¢.i'r. � $}�y�p r,3�,ry �(q r €e .�i£��S3A4rs(3�*j'Ttf EJa./,���p{€�C€¢-�(z.�[:^`-,it/�'`♦f�3�?��.!'s r€anairi-(.'.�.�,y+��{ €.....,µ..,.. y _ @ka. :. <br /> .,R ¢E. ... i.3Y..,...' <br /> fF.E,, .S.€„gra ;€, a �,¢ §€8 ¢ta? r, ,x N°`° €k p{, PE€€xI .i i 4 ,;SN <br /> s:;ONLY>THE`OWf IER'QF,,'T?f ;�?ROl?�R Pbl'.AN:1IIl FfbRIZED"A ENI MA'Y<,° 111-�tIV'°PPI ICA7ION 1013 <br /> !, the Owner/Agent agree, to defend,'indemnify,and hold harmless the County and its agents, officers and employees, from any claim, action <br /> or proceeding against the Owner/Agent's project. <br /> 1,further,certify under penalty of perjury Char l am(check one): <br /> i X Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the properry(s)involved in this <br /> I <br /> application,or <br /> i€ <br /> Legal agent(attach yroof of the owner's consent to the application of the property's involved in this application and have <br /> Ej been authorized to file on their behalf, and that the foregoing application statements are true and correct <br /> i <br /> Print Name: J� G I T(` Signature: p" Dale: 0-3 <br /> Print Name: ` ,�. �LAr� Signature; '�..a r ,�r � �,. Dater <br /> Print Name: - r Signature: " 5, r � �'`t :irla(-' Date: f--D Q�? <br /> Y <br /> Print Name: ��{f ' Signature; �, j'``' J y .'i' i Date: - ) ' <br /> Priat Name: Soo-H-1 4 G�.� v f�=� Signature: r!c '��f a :��.:�s G". J J� <br /> 7 Date: <br /> 1t 4 <br /> -71?/0 3 <br /> )EMy ,r -� <br /> Ij <br /> El <br /> E. <br /> E, <br /> Il <br /> E. <br /> I� <br /> li <br /> E , <br /> iJ ; <br /> E <br /> 'Y11 4 <br /> E, <br /> -4- <br /> 3 <br /> q. <br /> I � <br /> ! i! <br /> ! `I <br />