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f <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <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 Owner/Agent's project. <br /> 1, 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 /> Pnnt Name: 16—k-01 Signature: - Date:Z= _0-oZ0/3 <br /> Print Name: 6J� 1-/5✓e ja&m6c Signature: iiy _ Date:Z'« 1 _ <br /> Print Name: _ Signature: Date:------- .. <br /> Pnnt Name: Signature: Date:--------- <br /> Pnnt NameSignature: Date' <br /> F'ZFVSVPPIanrunp AppLCatpn Fo k Page 5 of 7 <br /> I nl I Iro GM,ntnwl IW' IRRV,VM1 frl-(IGI <br />