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II <br /> APPLICATION ® LOVO"'LINE ADJUSTMEN` <br /> t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEFAR-`\fiEN` <br /> FILE NUMBER: <br /> 1 <br /> AUTHORIZATION SIGNATURES <br /> I' ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FELE AN APPLICATION, <br /> IE , <br /> the OwnerrAgent agree: to defend, indemnify, and hold harmless the County and i s agents, offices <br /> E� employees from any claim. action: or proceeding against the Owner/Agent's project. <br /> VI further.. certi`y inder penalty of perjury that I am (check one): <br /> I? Legal prc•pe r-�y owner (owner includes partner; trustee. trustor, or corporate officer) of she oroperys <br /> involve:; in -`h"s application, or <br /> Lega'r ager-ft (attach proof of the owner's consent to the application of the property's if ivoived. in this <br /> app,ication ai-'d have been authorized to file on their behalf., and that the foregoing appitatioa staiemvn _ <br /> are true and correct. <br /> lir; t Na'ne: _vid C. Ferry, Trustee Signature: A )ate:, a c _ <br /> fZ <br /> orir Name: Ma Ann Perry, Trustee Signature: <br /> rY g Dale: <br /> i . :, Marne: Reba R. Turnbull , Trustee Signature: <br /> ffD ^t Name: Sarb_ra'S Nepote, Trustee Signature: 'Date i <br /> i~'.,Name. Si mire: Date., <br /> - <br /> I 9: <br /> P <br /> l �V5V�',Dl n..,�:^y Ao a <br /> 'c?-f: -..x=% P2ge 4 of .:��� � 2007-5E <br /> ._ci GE e Ad;usfinen;COC (Revea 6-4-0z) <br /> i� <br />