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oR�q"r7 <br /> .M =: y `APPLI <br /> CATION <br /> SAN JOAQUIN LOT LINE ADJ <br /> COUNTY COMMUNITY pEVELOPM U pEPNIENT <br /> <'ko ARTMENT <br /> FILE NUMBER: <br /> 7-7 <br /> AUTHOR14ATIpNr SIGNATURE <br /> ONLY THE O�NNER OF,THF PROPER. _77 <br /> S <br /> TY".OR AN AUTHQRIZEp AGENT MAy FILE gNgppLtCAT1.pN <br /> h the Owner/Agent agree, to defend, indemni <br /> fy, and hold employees from any claim, action or proceeding ago n t the p armless the Coun <br /> ty and its agents, officers and <br /> !, further, certify under penalty of pe • that 1 am {chweer/Agent's project. <br /> r!u ry (check one): <br /> Legal.Property owner(owner includes partner, trustee, <br /> involved in this application, or trustor, or corporate officer) of thero e <br /> p p rtY(s) <br /> ❑ Legal agent (attach proof of the owner's.consent to the application of the r <br /> application and have been authorized to file on their behalf., and that the foregoing application property's involved in this <br /> are true and correct g pp cation statements <br /> Print Name: <br /> Signatu <br /> Print Nam Date: <br /> 4/Signature. r <br /> Print Name: <br /> 5ignatur Date? <br /> Print Name: Date <br /> Signat re: <br /> Print Name: Date: <br /> Signature: <br /> Date: <br /> :0EVSVCNPlanning Application Forms\ page 5 of 7 <br /> of Line Adjustment.doc.(Revised 0-3-03) <br /> t <br />