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° 2 APPLICATION - LOT LINE ADJUSTMENT <br /> �. <br /> y, <br /> : �� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> , •�� <br /> �d<<FotzN� FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED 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 County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> M 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: William H.Eavenson Signature: v t--e . L Date: <br /> Print Name: Beverly A.Eavenson Signature: --�--�tt s gate: 3-�3 �s <br /> Print Name: Cynthia A. Henry Signature: E" ` V4- �'-� "�� Date:3- 7-3- 1;5 <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature: Date: <br /> F:0EVSVCWIann1ng Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />