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�-= c APPLICATION — LOT LINE ADJUSTMENT <br /> L' tl y <br /> a' a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • � P <br /> FILE NUMBER: � <br /> i <br /> { <br /> ..�µAUTHORIZATI�ON SIGNATURES <br /> ,._ <br /> {'. �. �` � �?„ gf ' �5�`�F''+S' '''f`� 4'1 <br /> - - .� � � �"r ✓ '�-• i, }Y vim;. ;. y� a. , p{ r,� ,j � r �� j'. <br /> GNLY,THE OWNER'QF THE;PROPERTY_QI ANAUTHORIZED'AGENT i1AAY4FlLE 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 /> E, further, certify under penalty of perjury that I am (check one): <br /> 4 <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 I <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: xADO_WT't '�,tr�Wl ea�+� Signature: Date: <br /> Print Name: Signature:_ Signature: Date: <br /> Print Name: Signature: �f Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> l <br /> } <br /> j <br /> I <br /> FMEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-3-03) <br />