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=' ` \ APPLICATION --- LOT LINE ADJUSTMENT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> --------------- <br /> FILE NUMBER: <br /> o% --�---- <br /> i <br /> ii <br /> AUTHORIZATION.,SIGNATURES <br /> ONLY THE OWNER OF THE.PROPERTY OR AN AUTHORIZE <br /> D AGENT MAY.FILE AN APPLICATION. <br /> I, 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 /> 1, 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 /> F1 Legal agent (attach proof l f 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: K 0 c'" ! r 0-4V Signature: f <br /> Print Name: irvi I � L Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: � Signature: Date, <br /> Print Name: Signature: Date:~�---~----- <br /> I <br /> FADEVSVMPlanning Application Forms\ Page Jr of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />