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tayln, APPLICATION — LOT LINE ADJUSTMENT <br /> C; <br /> 1< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �i ,.��'+ � ' e?u�ux.� <br /> ONLY THE OWN.ER:OF THE P OPERTY l ;, [ G;WNT 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 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 ave been authorized to file on their behalf., and that the foregoing application statements <br /> are true a corr ct. <br /> Print Name: Ignature: Date: <br /> Print Nam Signature DateL 'Z7— i/ <br /> Print Name: Signature: Date: <br /> 'I Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> POEVSVCWianningApplicarion Forms\ Page 5 of 7 <br /> Lol Line Adjuslmenl.doc.(Revised 6.3-03) <br />