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'OUlly <br /> APPLICATION <br /> LINE ADJUSTMENT <br /> 2 :- <br /> a< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _1.._7 FILE NUMBER: <br /> q<iFOR� <br /> AUTHORIZATION HORIZATjON SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT 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 County arising from 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 have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. //-- <br /> Print Name: ��l�cEl s/k/ `A Signature: Date:Z-��'z�1/� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSWPlanningApplication Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-Dg) <br />