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APPLICATION - LOT LINE ADJUSTMENT <br /> ` sr . <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Fy- <br /> I <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 1 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 be If., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: >tR D 75 E¢T S f L VA Signature: Date: ' 18-19 <br /> Print Name: tJPt-rALJar P $/L ✓A Signature: Date: <br /> Print Name: FRED A • �0 4 K�.__ Signature: Date: &//z <br /> Print Name: N AR L 6ri fJ "DoLt M Signature'. Date: �'%ty " / 7 <br /> Print Nam . FR6D A. DDLA,,AA Signature: Date: 2-4 <br /> ArR� PAizTNE f+t ' <br /> FADEVSVC\Plaming Appiicabon Forms\ Page 5 of 7 <br /> Lot Lure AdiUstmentdac.Meowd 64-04% <br />