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°P4u' APPLICATION - LOT LINE ADJUSTMENT <br /> z, r <br /> in: :t SAN JOA(2UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTH.QRIZA-10 :SIGNATURES <br /> ONLY.T,HE OW14EFi OF.THE.PROPERTY',OR AN.AUTFLORIZED AGENT MAY I=I E'AN:APPf_ICATION. <br /> 1, 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, further, certify under penalty of perjury that i am (check one): <br /> 0/'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 /> a are true and correct. <br /> Print Name: b f L L <br /> ! . g L� �✓1 J"; 'rr�K....• <br /> r �-✓��� Signature: Date: <br />' Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> a <br /> Print Name: Signature: Date: <br /> T <br /> I <br /> POEVSVG Planning Application Fonnsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />