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%;..'PLICATION -- LOT L,-,4E ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `• 1. . <br /> C1. <br /> FILE NUMBER: <br /> AUTHORIZATIb'N-:SIGNATURES.° <br /> ONLY THE OWNER OF THE PROPERTY:OR AN AUTHORIZED AGENT MAY FILEJAA <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and itemployees from any claim, action or proceedingagainst 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) o <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: Gary J.Augusto )( .a <br /> )Signature: X <br /> L <br /> Print Name: ShirleyJ.Augusto )(Signature: ' <br /> te: <br /> Print Name; Signature: J <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: { <br /> PTEVSVC\Ptanning App;kation Forms\ Page 3 of 3 <br /> Lot Line Adiustmeni.doc.(Revised 64-04) Job No 2005-264 LLA <br />