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0PgUIN.\c <br />�l <br />Q�iFORN/ <br />APPLICATION - LOT LINE ADJUSTMENT <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER: <br />AUTHORIZATION SIGNATURES <br />ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 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 />Daniel F. Roza, Jr. <br />Print Name: Daniel F. Roza, Jr. Signature: n Date: II " Z )-/G <br />Daniel F. Roza, Trustee of the Daniel F. Roza 2010 Property Trust /DR D ad}Sept e� �er 29, 2010 / <br />Print Name: Daniel F. Roza, Trustee Signature: Date: <br />r <br />, <br />Print Name: Gregory Torlai Signature: ate:/ ' 21 <br />Print Name: Laura Torlai Signature: Z R Date: Z ' <br />FADEVSMPlanning Application Forms\ Page 3 of 3 Job No 2016-245 LLA <br />Lot Line Adjustment.doc. (Revised 05-11-09) <br />