Laserfiche WebLink
,,. <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHOR ZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILEAN APPLICATION. <br /> fftoewner/Agent agree,to defend, indemnity,and hold harmless the County and its agents, officers and employees <br /> rom any claim, action or proceeding against the Owner/Agent's project. <br /> I, turther,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) involved in <br /> X <br /> this application, or <br /> Legal agent(attach proof of the owner's consent to the application of the property(s) involved in this application <br /> and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print <br /> Name: Derrol Elliott Signature: Cate .2 <br /> prim _ <br /> Name: Edith Elliott Signature: pate: <br /> Print �- / <br /> [rLint <br /> . Robeck,Trustee Signature: �'--'- G, G� Oate: Z-/Z-3/0,C <br /> r <br /> Robeck,Trustee signature: Date: <br /> Signature: <br /> Date: <br /> F:DEVSvClpynning APprcatbn Forms/ <br /> LOt Line AdJuetment dog.(Revised 06-04.04) <br /> Page 3 of 3 <br /> ti tttiUsu.■— y job.N;20n,-;� <br />