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.G APPLICATION LOT LINE AD <br /> 0�,: �- ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •. .P FILE NUMBER: <br /> q�1koRr' <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 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 /> 42 <br /> Print Nam 4� Signature: OaA. A. LvY f <br /> t{r�.__ Date: 45&$ <br /> Print Name )<'/t,/4'?r j" --- Signature: /�' �� bate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> F:1pEVSVC\P1anning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustmeat.doc. (Revised 6-4-04) <br />