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APPLICATION -- LOT LINE ADJUSTMENT <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER: <br />i AUT OR <br />ZA ON, IGNATORES' <br />ONLY THE OWNER OIF THE, P. ROPE'FiT OR AN AUT1-OPIZE® AGENTMAYFIILE AN APPLICATION. <br />1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br />I employees from any claim, action or proceeding against the County arising from 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 />17 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 />I <br />Print Name: Steven A. Kaiser Signature: ''f/,A r Date:_ <br />3 <br />Print Name: Sails L. Kaiser Signature: Date: f <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />i <br />Print Name: Signature: Date: <br />1:1,DEVSVC1PIanning Applicalion Formsl Page 3 Of 3 Job No 2011-167 Lot Line Adjustment.doc <br />Lot Line Adjustment.doc, (Revised fly -11-09) <br />