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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> y :< <br /> 9ef oi'`P FILE NUMBER: <br /> AUTHORIZATION SIGN T'.f _ <br /> ONLY'THE OWNER OF THE PROPERTY OR AN AUTHORIZED-AGENT MAY FILE�AN APpu ATlON. <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 /> 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 /> Print Name: 1i'i'• dA ov jZ„ ` Signature: Ct Date: M ZOD7 <br /> Print Name: aVAe/#q �14SSr9 LL Signature: Date: �bL ,00 <br /> Print Name: 1 Signature: Date: D <br /> Print Name: • Jh Signature: Date: D ZGi07 <br /> Print Name: l 1 Signature: <br /> Date: CM O <br /> D L WJ <br /> �1n1� � t3✓'�( <br /> FIpEV5VOPfanning Application Formyl Page 5 of 7 <br /> Loi Line Adiustment.doc.(Revised 6-4-04) <br />