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APPLICATION - LOT LINE A®JUSTIilIEN1" <br /> j 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 /> 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 County arising from 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 /> ❑ 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 /> ?T� l / �aE�a7st�'l <br /> Print Name: rL�F�ih U JO/JI?Sctn �h1tA i LL l� �? K <br /> Signature: ate. <br /> Print Name \�Z"A-E. l "E'(L t,--a Signature: �b ? Date:I I- <br /> Print Name �L-�)dL{ �` �i Signaiur Datell �la� <br /> Print Name: Signature: Date:_ <br /> Print Name: Signature: Date: <br /> r <br /> F-MEVSMPlanning Application Fortes\ Page 5 of 7 <br /> Lot Line Adjustmentdoc.(Revised 05-11-09) <br />