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APPLICATION -- LOT LINE ADJUSTMENT <br /> Q f <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> '¢CrFpRV� <br /> AUTHORIZATION SIGNATURES <br /> ONLYTHE OWNER OF THE PROPERTY.OR.AN~AUTHO .R IZED AG <br /> ENT fMAY 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 Owner/Agent's project. <br /> i <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: J-09A4 C Signature: `4 1 l G �� Date: l �� <br /> Print Name: Q1�.►�-�F:t"f�" ft�_ S r,4 bL,--CtSignature: � Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F 1DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />