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r°\ t.PPLICATION — LOT a;_,IVE ADJUSTMENT I <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `J^� FILE NUMBER: <br /> i <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AWAUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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): I <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: Kenneth L. Roos,Trustee Signature:K_ Date: <br /> Print Name: Margaret Roos Trustee Signature:K Date: <br /> Print Name; David L. Roos Signature: -, Date: L <br /> Print!Name: Gina Marie Roos Signature: Date: <br /> Print Name: Signature: Date: <br /> FZEVSVC1Planning Appkation Forms! Page 3 of 3 Job No 2007-109LLA.doc <br /> Lot Line Adjustment doc.(Revised 5-4-04) <br />