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P�uia APPLICATION - LOT LINE ADJUSTMENT <br /> �a�r cp_G <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ��CIFO't�t1�P FILE NUMBER: <br /> kUTH:ORI°ZAT :OIVtSIGNATURES � <br /> ONLY THE OWNER OF.'.THI= IPROPERTY:OR.AN AUTHORIZED-AGENT MAIC;FILE ANyAPPLICATllbit ' <br /> i <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(oI v ner includes partner, trustee, trustor, or corporate officer of the e <br /> involved in this application, or ) prop rtY(s) <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: \A'-'I"-0- F- tk^k l Signature: Date: Q 3007 <br /> t <br /> Print Name: (A),11tAWX },. M signature: <br /> �7 Date: (9S O1 07 <br /> Print Name: Q' uu t e. o I 0 LAA.- Signature: Date:d s(d� 07 <br /> Print Name: Signature: Date: <br /> tntName: I>A&I IL s1 Signature: Date:DS of 107 <br /> i <br /> I <br /> i <br /> i <br /> FADEVSVOPlanning Application Fonns% Page 5 of 7 <br /> Lot Line Adjustmentdoc,(Revised 6-4-04) <br />