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LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> MIR %`s.?-�• : 'AUTHORIZED 31GNATURES <br /> Mgt ONLY THE O WNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE ANAPPLICATION <br /> I,the Owner/Agent agree, to defend, indemnify. and hold harmless the County and its agents, officers and employees, from any claim, action <br /> or proceeding against the Owner/Agent's project. <br /> 1,further,certify under penalty of perjury that I 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 /> 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; rn.(/( Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> -4- <br />