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., _ s• r <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> aNE` WNt±R.O THE'PRflPER'f`Y R• `-• <br /> �! AN AUTHDR¢Ep;AGi=1itT'MAYIL ` : <:; <br /> Q►j11;.pPPIJ TIQN: <br /> 1, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and Its agents, officers and <br /> employees from any claire, action or proceeding against the County arising from the OwnerlAgent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner includes partner,trustee,trustor, or corporateofficer),of the proper ty(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 /> PrintName: rIZl�d ,�,�1•r Signature: �, <br /> U)CE esF Date: <br /> Print Name: l�./�+ Signature: <br /> Rafe: <br /> Print Name- Signature: <br /> Date: <br /> Print Name: <br /> Signature:re. <br />� Dete: <br /> PrintName: SFanature: <br /> Date: <br /> F:IDEVSVQPlanning Appkalion Formsl Page 5 of 7 <br /> Lot Lane Ad)ustment.doa(Revised 05-11-09) <br />