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rALICATION - LOT ,LINE <br /> 1 PPADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 111,'•. <br /> it h fFo AN" FILE NUMBER: <br /> I <br /> AUTHORIZATION SIGNATURES <br /> �r <br /> ONLY THE 01MNE0 OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ' 11 the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any elaim, action or proceeding against the Owner/Agent's project. ? <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ' I <br /> I® Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> f. <br /> i <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 /> Print Name: NANETTE MARTIN ` <br /> . Signature: .�/ �7 '� '�i� %' =, (� Date: <br /> Print Name: Signature: Date: <br /> Print Name; Signature: Date: <br /> 3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> H <br /> I <br /> i <br /> I <br /> 1 <br /> i <br /> Y <br /> F:TEVSVC1Planning Application Formsl Page 3 of 3 <br /> Lot Line Adjustment.doc (Revised 6-4-04) Job No 2006-146 LLA <br /> 3 <br /> Ei 3 <br /> s <br />