Laserfiche WebLink
°mac° APPLICATION - LOT LINE ADJUSTMENT <br /> y f ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> . <br /> R '� � '� r S 9.roy_'�' `} n '� i h-3'5x. <br /> 5, 4 h St R' 1 i'' F rr V ,r^ � � S K <br /> .h 'fir' 1 F. 3l { i'x., Y a�n A fi 0 1 � ,A �"G NA <br /> _ t <br /> c�$r.. t.- .1:x.5..- :':. _ .N.. - `"� �: F <br /> - n,..a.wL,. <br /> � ��NLYE��W�I�R OF�_1E��R�P,�E;I�gTY,�"OR�AM�AUTHO�iZEQ:�AG,�N ��LA►Y�F���AN �PPLIC�►TI(�N � , <br /> I, the OwnerlAgent agree, to defend, rndernnify,._"and hold harrrtless the county and its agents, officers and <br /> employees from any clam, action or<proce ding against"the"QwnerlAgent's:project. <br /> 1, fust er, certify under penalty of perjury that-'1 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 /> Print Name: ;` Signature:, r Date: 'j�p e <br /> Print Name. f Signature: Date: <br /> Print Name: Signature Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> F:IDEVSVC)PlanningApplication Forms\ Page 5 of 7 <br /> Lot Line Adiustment.doc.(Revised 6-3-63) <br />