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F <br /> r <br /> •M = r T LINE ADJUSTMENT <br /> SAN JOAQuw COUNTY cOMMuN1TY DEVELOPMENT DEPARTMENT <br /> AU77lQRIZAMN SIGNATURES <br /> 1NtYTFILOWNER OFTHI:PROPEFftYOR/UV'A0rH0MZED:AGENTMAYF1LEAN Af+PWCA77bN <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employes$from any claim,action or <br /> proceeding against the Owner/AgenPs project <br /> 1,further, certify under penalty of perjury that l am(check one): <br /> O Legal property owner(owner Includes partner,trustee,trustor,or corporate office)of the property(s)involved in this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Invohred In this appilcadon and have <br /> been aLIMW&ed to file on their behalf.,and that the foregoing applicatlon statements are true and correct: <br /> r <br /> Print Name: Law r-,e. � f f� 5i nature: <br /> 9' bate: % C) <br /> Print Name: LU f -r Signature: LL��A) pate; 44-a f <br /> Print Name: Signature: pate: <br /> Print Nam: Signature: pate; <br /> Print Name: Signature: Date: <br /> , <br /> t <br /> I <br /> I. <br /> i <br /> 4 <br /> ii <br /> 10:03AMPA LA88 FeWdwy 7,7888 <br /> -4- <br /> �F , <br />