Laserfiche WebLink
,�A� - APPLICATION - LOT La4E ADJUSTMENT <br /> �` .fi�j ; SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Q: , <br /> is <br /> \\c,-_.. ..P FILE NUMBER: <br /> \Gi_c oRN/ <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, indernnify, and hold harmless the County and its agents, officers and employees <br /> 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 /> X Legal property owner (owner includes partner, trustee, trustor or corporate officer) of the property(s) involved in <br /> this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> IkAo <br /> and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print .� <br /> Name: Nat Bacchettl,trustee Signature: '� ,• ('��.`Q,g Date:? <br /> Print / n i <br /> Name: Marie Ann Bacchetti,trustee Signature:: O-A � L ,,.` Iatccc Y 2 G Date: <br /> Print p <br /> Name: Gurinder Singh Grewal,trustee Signaturex__,42-' V Dat�j/6/o! <br /> Print '//� <br /> Name: Gurmail Kour Grewal,trustee Signature: �,�(Lrcaaj Kou✓ ��c w` Date: Q <br /> Print <br /> Name: Signature: Date: <br /> F:DEVSVC/Planning Application Forms/ <br /> Lot Line Adjustment doc. (Revised 06-04-04) Page 3 of 3 Job No 2005-125 <br />