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04/06/2010 09:45 2092398 MCR ENGINEERING PAGE 05 <br /> A - 2492398839 <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> >w '� FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 /> 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 /> Gbt_ Pi�7l�5 Gl,.0 i l <br /> Print Name: �+ E �I O� Signature; D <br /> Print Name; Signature: Da <br /> Print Name: Signature: De1.e: <br /> Print Name: Signature: Date; <br /> Print Name: Signature_ Date: <br /> r <br /> F!0EVSVC1P1Anning Appllcaflon Formsl Page 5 of 7 <br /> l.ei Lino AIM.-brow-dor.(Rr;viu,�d 8-4.04) - - . <br />