Laserfiche WebLink
APPLICATION - L01r INE ADJUSTMENT <br /> a <br /> (5iSAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT QEPARTMENT <br /> <i <br /> ' FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> rhe <br /> HE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> er/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> certify under penalty of perjury that I am (check one): <br /> property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> ed in this application, or <br /> 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 /> _A <br /> Print Name: Cynthia R. Alfieri, L7 NO L <br /> as Successor Trustee Date: <br /> Print Name: Cynthia R.Alfieri, �' f`�r. `` ~ <br /> Date: <br /> as individual Si6aatsuie.% f 44.,l <br /> f <br /> Print Name: Signa " e: i/ Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> w <br /> i <br /> F:NnPVSVC\Piannmg Application Forms\ Page 3 of 3 Job No 2007-234 blA.doc <br /> lot Line Ad}ustment.dec.(Revised 6.4-04) <br />