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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> i <br /> i <br /> :e Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and :! <br /> _--oiovees from anv claim, action or proceeding against the Owner/Agent's project. <br /> -__.Freer. certify ;ender penalty of perjury that I am (check one): <br /> Legai property Owner (owner includes partner; trustee, trustor, or corporate officer) of the property(s) <br /> invo!ved in this application, or <br /> !I <br /> mm. Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> app=,ication and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> i' <br /> Signature: f / Dater <br /> Kurt A. Kautz g <br /> �7ate <br /> Signature: <br /> Signature: Date: <br /> ��a•7 e 9 <br /> Signature: - <br /> r�cte: <br /> _-._. _ _.. . <br /> Si nature: Date. <br /> g <br /> 'J�vc ParnEngApphc;ato^Fcr;.a Page 3 of 3 Sob No 2011-122 Lop Line Adjus:mer_ <br /> Atl;�_t"en1 doc [ftcv!srC�1-�G; <br />