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'PLICATION - LOT LUE ADJUSTMENT <br /> w ` x SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Wx <br /> e 5 4 k ''H'��c `4 y '"'W_FGi St iw r e i rr R k <br /> 710 <br /> LY'THE QINNER.OF'�HE PR�?P R'CYt ?,R T� AlAUT0l 1 l p,�C�,1;IVT l�AY,FI,I!l� gPFLtGATIQN.. <br /> S <br /> 1, 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 /> 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 /> J.7- iegal 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 /> 62 <br /> Print Name: DYY1q V Signature:f` Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> FADEVSVDIPianning Application Forms\ Page 5 of 7 <br /> Lot Line Adiustment.doc.(Revised a-3-03) <br /> i <br />