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f <br /> f , APPLICATION - LOT LIME ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Rk <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 owners (owner includes partner, trustee, trustor, or corporate officer) of the property(s) i <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: 77,#- 4 ,9. 7Twf" Si g mature: hvw�a2 -� Date: X=10-07 <br /> Print Name—Signature: Date: -- "05- <br /> Print Name: D-0-0 <br /> a u ' s f Signature: Date: —CJ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> M <br /> i <br /> F:IDEV5VMPlanning Application Forms\) Page 5 of 7 <br /> Lot Line Adjustment.doc (Revised 6-04-04 <br />