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r = <br /> y QqqL "FAAPPLICATION - LOT L`W�E ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> A <br /> 1 <br /> 4AUTF ?Rf T OIC S1` OF . <br /> 11"11,11the <br /> QNLY THS°9u11N fi�F THErRR �ER'1 Q,2./�NUTHOREp AGENT IUI/ Y.FIL�AN APPi�ICATIf9jand <br /> Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers <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 a property's involved in this <br /> application and have been authorized to file on their behaL an at t foregoing application statements <br /> are true and correct. <br /> Print Name: Signa r Date: / - I ,?'y t'S <br /> Print Name: Sig tura: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ROEVSMPlanning Application Forms% Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 63.03) <br />