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y <br /> Y <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,rte f FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE 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 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: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: • - - Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: rcc Z- I Signature: [ dmlp. 4 Date: <br /> 2or o <br /> -Tf 4-a"7S'f L Ie ; vheR do her�e�� C0k2 send <br /> --�(o Ec.- ) er, , k-, 1/6C c..t 42 .ii C)&L 4� a C- e- i,,l <br /> 5 I <br /> avt -el Le-'O- al Tiaws 4o Seeh <br /> ©c� ,r� �a c�-�•t -�- ~�o t� � e �ce,�L-� s e s C� " b ec� <br /> p K I <br /> 20!D <br /> a Fo-,9 u o cf e 51. otij k7 e 12 do h e r,,- b� <br /> o E b e.i rn f�eq cx I M eh f' � <br /> �pcs � ® .� � e FMS Prl+, P,,1,x+eCf <br /> oseseSc� it hc � C)k7 • <br /> J i�u Q F�� u � 3 <br /> F11]EVSVC--PlanningApplici Fprms[ Pages of <br /> Lot Line Adiustment.doc.IRevised 64-G4) <br /> e. <br />