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C <br /> �a�•{n. APPLICATION -- LOT LINE ADJUSTMENT <br /> �.• .o� <br /> .y� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> y' < <br /> FILE NUMBER: <br /> •P <br /> AUTHORIZAT12M,. !gffATUR�ES,� <br /> ., A'�!51} Y•y -,'1 .+I "..'?', �`Y� l4y ii. y'; _'�:- <br /> f ONLY THE OWNER 011F <br /> EL <br /> (r}Ft AN`I�i "i'HO�tI 'I D�iC I �";IVIAY, ILEE 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/Agenfs project. <br /> I,further, certify under penalty of perjury that I am (check one): <br /> tee trustor, or corporate officer)of the property(s) <br /> artner, trustee,IkO <br /> Legal property owner(owner includes p , <br /> involved in this application, or <br /> attach roof of the owner's consent to the application of the property's involved in this <br /> ❑ Legal agent { P <br /> file on their behalf., and that the foregoing application statements <br /> application and have been authorized to <br /> are true and correct. <br /> ate: 101 is I l C <br /> Print Name-I o i u C.C- /12.5 L_ Signature' <br /> Print Name: <br /> Signature' Data: <br /> Print Name: <br /> Signature: vete' <br /> Print Name: <br /> Signature: Date' <br /> Print Name: <br /> Signature: Date: <br /> I <br /> F,.\DEvsvclPianning Application Forms Page 5 of 7 <br /> Lot Line Adyustment.doa.(Revised 05-11-09) <br />