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�?g-•.ter° 'APPLICATION LOT LINE ADJUSTMENT. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER <br /> `} •' a`' Qty IliaF ��` yr � Efi .( EQCT�O1 <br /> ., the OwnerlAgent-age ee,':to defend indemnify, and hold:harrniess the County acid its agents, officers and <br /> employees from any:clalm ;aeon;ar proceedirig against tfle OvvnerlAgent's.pro)ect . <br /> I, further, cerfify under patty of;per)ury that l am (check one).' <br /> F1 Legal property owner(owner includes paitrter, 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 fjehalf; and that the foregoing application statements <br /> are true an correct. <br /> Print Name: Sig natur Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: -Signature: Date: <br /> FADEVSVOAanning Application Forms\ Page 5 of 7 <br /> Lot tine Adjustment.doc.(Revised"-03) <br />