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r <br /> °"4Y1i APPLICATION - LOT LINE ADJUSTMENT <br /> `•` < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :•� FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY 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 County arising from the Owner/Agent's project. <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: Signature: <br /> Print Name: <br /> a.&4 C s Signature: <br /> Print Name: Signature: <br /> Print Name: '�,, e �, V\. n oS 5 c8ignature: _ 10 D <br /> Print Name: Signature: <br /> ROEVSMPIenning Application Forrrsl Page 5 of 7 <br /> Lot Line Adjustmenl.doc.(Revised 0511-09) <br />