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- nG APPLICATION — LOT LINE ADJUSTMENT <br /> .z <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 /> e Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> )'ovees from any claim, action or proceeding against the Owner/Agent's project. <br /> :. � i Ther. certify under penalty of perjury that I am (check one): <br /> i <br /> I <br /> '_egal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> ir�volved in this application, or !j <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 I' <br /> 2rc; tree and correct. <br /> ' _.._.... Signature: 1~ Date: ;. ' <br /> I^�Gn�E flU�6 P1. f�C�.uiL Sigtate: <br /> Signature: Date_ II <br /> ane Signature: Date <br /> t'G:ne: Signature- Date: <br /> Signature: Date <br /> V5VC%P!arn-iinq Apocatic-=Fonrs', Page 3 of 3 Job No 2011-166 Lo!Line AdjUSI -te-' <br /> ,�Ad,uSla�ent d0 c. [Revised 6- -CA) <br />............................................................................................ <br /> ................. <br />