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l <br /> LOT LINE ADJUSTMENT <br /> 9A&JQAQVAI CQVYTY C MMUNI REVEL PMEN DEPARTMENT <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,oNlcers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> L <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> Legal property ort ner(owner Includes.partner, trustee,grantor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> I <br /> Print Name: "Q C rr 1^1 S Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> 4 <br /> If <br /> 1 <br /> I <br /> e <br /> f <br /> 1rOEY/EK/IUARK/PL.MWn/w LZNEAWAreroxw Rev 2llrf1 -q- <br /> I <br />