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>: APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1.. = FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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 County arising from 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)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: Jose R.Fonseca Signature: � z� !y� Circ Date: /bfice <br /> Print Name: Dolores R.Fonseca Signature: Date: <br /> Print Name: Pavel Wkhrestov Signature: Date: <br /> Jack Klein Trust Partnership <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FA0EV8VC1P1wrJng Appllcaeon Forms% Page 3 of 3 Job No2014-22911a <br /> Lot Line AdjustmenUm(Re�iaed 05-11-09) <br />