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I <br /> --------------------- <br /> APPLICATION - LOT LINE <br /> 1*4 '' UIN ADJUSTME <br /> .� SAN JOAQCOUNTY COMMUNITY DEVELOPMENT NT <br /> _ I NT DEPARTMENT <br /> FILE NUMBER: i <br /> ! <br /> I <br /> 1 AUTHORIZATj IV S'IGNATUR <br /> ES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED A <br /> f' GENT MAY E!I_E AN APPLICATION. <br /> >> the Owner/Agent agree, to defend, indemnify, and hold harmless the Coo <br /> i employees from any claim, action or proceeding against the Owner/Agent's e County and its agents, officers and <br /> <i g nt's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> 3i <br /> !i Legal property owner (owner includes partner, trustee, trustor, or corporate officer) <br /> involved in this application, or cer) of the Property(s) <br /> i <br /> Legal agent (attach proof of the owner's consent to the application of theproperty's <br /> ,i application and have been authorized to file on their behalf,, and that the foregoing ap involved in this <br /> are true and correct. going application statements <br /> Print Name: Barbara A. Martinsen Seneficia ! <br /> ! .. Signator <br /> �'rint Name: Ernest Martinson <br /> Date: <br /> i ` , <br /> it Signature: .-.; ; c _ <br />.i 3rint Name: f ��.rte Late: <br /> Signature: <br />!! Tint Name: Date.- <br /> Signature: <br /> ate:Signature: <br /> °Tint Name: Date: - f <br /> Signature: I <br /> Date: <br /> EVSVC1Plannmq Application Formsl <br />.ine Adjustment doc (Revised 6-4-04) page 3 of <br /> .IOI7 No 2007-86 LLA.doc <br />