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APPLICATION - LOT LINE ADJUSTMENT <br /> i t SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> . LIF pr+ <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 /> ❑ 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: `. h= Signature: Date: �Y 0 <br /> Print Name: i t`� '�/ �`tR.. Signature: Date: o <br /> Print Name: 1 c°" L Signature: Date:< �/n - /Z <br /> Print Name. ti `� jA it Ad C, Signature: Date: � O /Z <br /> Print Name: Signature: Date: <br /> F.OEVSVOtPlanning/+PPltratlon Forms\ Page 5 of 7 <br /> Lot Lina Adjust"ritAm.(Revised 0571-09) <br />