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Mau` 66 05 10: 33a <br /> " ' 95Y96/2Ai5 19:29 289-9 � 5555555555 v <br /> P. 1 <br /> CENTURY 21 PROP <br /> r PAGE 61/01 <br /> -- APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COURW COM1iMUNr1Y DOMLOPMEIrrE DEPAWMENT <br /> FILE KUMBEW <br /> .r ;'. ••:•_. ... (' ,r75•�,. {t�•y r�•ti yid �{• � . .•�•Y e.•" <br /> OPiE'Y 7Fii� iF.R oiO�! , iR' �JTHR{ZEp AC3E Illy AN APPLICAII1�W, <br /> 11, the Owner! <br /> 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 OwnerfAgenfs project <br /> I, <br /> Ze9al <br /> certify under penaltyof perjury that I am(check one): <br /> property owner(owner includes partner,trustee.trustor,or corporate officer)of the property(s) <br /> involved in this appli sdoi ;,or <br /> Legal agent(attach.proof of the owners consent to the application of the property's involved in this <br /> application and have teen authorized to file on their behalf.,and that the foregoing application statements <br /> are true and I <br /> Print Neme: S�pnatere: Dat <br /> i <br /> PrirgNarr+c: ,.:S rr,�nr,,,r, Sims <br /> Print Name: - �..� �## 51$rsature: Gate: <br /> Print Nasse: �..! Signature• Date: <br /> PFMName: Signature: Date: <br /> t. <br /> Page.5 of 7 } <br />