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LOT LINE ADJUSTMENT' <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1 3 tetd �S; _, - <br /> t� fl`f R1�175�1+NAT[IRS • ,g x <br /> a }rx r r' S is A(lT D 7 OVMS, <br /> ` n <br /> ent agree, to defend,indemnify,and hold harmless the County and its agents,of <br /> 9 g f ficers and employees,from any claim,action <br /> 1, the Owner/A <br /> or proceeding against the Owner/Agent's project. „t <br /> i,further,certify under penalty of perjury that 1 am(check one):, <br /> X Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> I <br /> I <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: Signature Date; o���-t, <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: } <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> - i <br /> i <br /> f <br /> i <br /> z <br /> ]I <br /> f <br /> 5 <br /> .Q. <br /> S <br />