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K PflutN <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> e SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Al1YH0RIZATI0N SIGNATURES._ , <br /> oNLYTHE.C) I bFINE.PIROPERTY OR AN-AU7NORI ECI ACoENT IVIIAd(-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 /> 1,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 /> t are true and correct. <br /> Print Name: Signature:6- <br /> 4T40zie4 // <br /> 1 Date: <br /> / <br /> sign; ure: Date:Print Name: atC <br /> Led <br /> Print NaAe: Signature, i Date: M11 <br /> Print Narng: kAul2/,E Date: lo&y�j/ <br /> Print Name: Signature: . Date: <br /> ! F:IDEVSVOFUnning App cet Fomrsl Page 5 of 7 <br /> Lot LMe AdjuslmentAm(Revised 0571-00) <br /> I <br />