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r <br /> Y .r <br /> - cd�Ay APPLICATION -- LOT LIFE ADJUSTMENT <br /> a; .4 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • . . _ .A FILE NUMBER: <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, 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 /> 1, 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: Arthur Tov Signature: Date: 03/08/2006 <br /> Print Name: Patricia Jane Toy Signature: . .-. ate: 03/08/2006 <br /> i <br /> F:kDEVSVC\Planning Application Forms) Page cJ of 7 <br /> Lot line Adjustment-doc.(Revised 6-4-04) <br />