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APPLICATION - LOT LINE ADJUSTMENT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \ā€¢.ā€¢ e FILE NUMBER: <br /> ---------------- <br /> 1FOR%' <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 County arising from the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am (check one): <br /> Q Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ā‘ 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. p <br /> Print Name: Ruth Anne Hendricks Signature: t..clz .L i Date: <br /> Print Name: Howard L. Elwess Jr. Signature: Date: <br /> Sheri Elwess .G- /Sā€”((' <br /> Print Name. Signature. Date. <br /> Print Name: Ryan E. Brenner Signature: Date: Jam,, <br /> Print Name: Suzanne M. Brenner Signature: to <br /> Date: Ls-_ <br /> F:\DEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />