Laserfiche WebLink
-APPLICATION LOINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . Vi 7., <br /> FILE NUMBER: <br /> AUTHORIZATIONI 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 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 /> Print Name: ROBERT E.WESTSTEYN Signature: , rrj �) "� Date: <br /> Print Name: JOANN WESTSTEYN Signature' ' W - Date <br /> Print Name: DALE W.JOHNSON Signature: '' ��y. Date( <br /> Print!Name: KAREN M.JOHNSON Signature: ���„���ry. �=��,r1:r-f.�` Date: . f <br /> Print Name: Signature: Date: <br /> PIDEVSVC\Pianning Application Forms! Page 3 of 3 Job No 2009-04 LLA.doc <br /> Lot Line Adjustment.doc.(Revised 5-4-04) <br />