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APPLICATION - LOT LINE ADJUSTMENT <br /> z,,A�N J02�.Q'J1iN COJUNTY CON1%IUVTY DLVE�-(DRME-NT CE=ARTM=-, T <br /> FILE HUMBER: <br /> jl AUTHORIZATION SIGNATURES <br /> it 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 Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I 2M (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�. Date <br /> 1-Print Name: &gnatur <br /> ate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />