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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> FE I I <br /> AUTHORIZATION SIGNATU <br /> i <br /> ONLYTHE 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 an <br /> employees from any claim,action or proceeding against the Owner/Agent's project. <br /> E <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 /> I <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 statement <br /> i are true and correct. <br /> I <br /> I <br /> Print Name: wt L ,rC� C�Ly—�� a t u r �j Date: <br /> i (IXIV2,� L/J (J�Iy�T/ Signature: j +� Date: <br /> ?Print Name: i ` �� <br /> Print Name: j Signature: Date: <br /> Print Name:Name: ! Signature: Date: I <br /> -Print Name: i Signature: Date: <br /> j E <br /> EE i <br /> I <br /> IE I� <br /> I <br /> C <br /> i <br /> } <br /> f <br /> I <br /> I <br /> I <br /> I <br /> I <br /> E <br /> RWEVSWUlanning Application Forms\\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br /> M <br />