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APPLICATION <br /> L07' ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> l <br /> AU 4 <br /> ONLYr <br /> THE OWNER QF..7HEPRfl ?ER,� <br /> !, the Owner/Agent agree, t r�UTHflRlZ t GE1''T M,AY-FILE AN APP <br /> LIC o defend, indemnify, and hold harmless the County and its agents,LoCicers a, <br /> employees from any claim, action or proceeding against the Owner/Agent's <br /> project, g � fF�cers and <br /> 1, further, certify under penalty of perjury that I am (check one): i <br /> i� <br /> ® Legal property owner (owner includes partner, trustee, I. <br /> or e, trustor, or corporate officer) of the property(s) <br /> involved in this application <br /> ❑ Legal agent (attach proof of the owner's consent to theapplication <br /> application and have been authorized to file on their behlf, and that the foregoing <br /> involved in this <br /> are true and correct. <br /> going application statements I <br /> Print Name: K'rmberiV J. Horner Successor Trustee <br /> Print Name: j Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Signature: Date: <br /> `-- �---- <br /> Print Marne: Date: <br /> E: <br /> Signature: <br /> Date: <br /> FZEVSVC1Planning Application FcrmsV <br /> Lot Line Adjustmentdoc.(Revised 6-4-04) Page 3 of 3 <br /> Jab No 2005-132 <br /> I <br /> S <br />