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s � <br /> x .y <br /> r. <br /> ` APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �`4• FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 th regoing application statements <br /> are true and correct. 1 <br /> Prim Nam U 1V gnatur r 4 <br /> Date: I q 0`s <br /> Print Na e. Ct Signature. Date: v2 <br /> s <br /> Print Name: <br /> 5ignaty e;:' Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> F;0EVSVCIPianning Appllcaton Formsl Page 5 of 7 <br /> Lot Lire Adjusvnemdo4(Revised 6.4-04) <br /> P <br />