Laserfiche WebLink
-f APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> } AuTMOwzATiON:316NATURES 'l <br /> fi ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APP6CATI6N <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 OwnerlAgent'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 owners consent to the application of the p s involved in s Itatements <br /> application and have been authorized to file on their behalf., and that the foregoing app <br /> are true and correct <br /> Name: ///4) �Cl,0ti signature: �/� Dom; <br /> Print Name: <br /> Print Name: <br /> 4ez"I/-, 542krz Signature: c Date: <br /> Print Name: C6Nrtis ESE " t� Signature: l Date: <br /> Date. <br /> Print Name: ILNInj i.fuifi.W1 cyt Signature: <br /> 9-25-15 <br /> Print Name: <br /> Signature: Date' <br /> V�J, �llatt� S eS — ✓cB CtiG,lrna.z <br /> ��.trs(s �s�.sls�t,S — atsa�2 <br /> IC�Jinl is�ftSD�'(41 — Ot�>.tsR <br /> FMIN& page 5 of 7 <br /> tat urw *0—t.mc"W" oo-iiw) <br />