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z <br /> v raury-, <br /> APPLICATION -- LOQ` LINE ADJUST' ANT <br /> SAN JOAQUINCOUNTY Cots MUttlTy OEVELOPMENT DEPARTMENT <br /> FILE NUMBER- <br /> f <br /> AUT110 I ATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY 1=i1_E AN!{PPLiCATfO <br /> #, the Owner/Agent agree, to defend„ it�desnr� armless �� <br /> employees from arry clafsn,, action or proceeding against thehOwner/Agent's R o ecthe CovntY �nd its agents, officers and <br /> 1, further, certify under persafty of per ury that f asst (check one)_ <br /> Legal Property owner(owner includes Partner. trustee,truster, or Corporate officer)of the property(s)involved in this application, or <br /> Ej Legal agent attach proof of the owners covsenl to tate apPlica.tion of tate propedy°,s involved in this <br /> al)Wication and have lin authorized to file on their behalf.,and that the foregoing application statements <br /> are tree and correct. <br /> Print Name: E <br /> Print Nantes: i <br /> Signature: <br /> Print Name., - Date: <br /> _ e:_ <br /> Print Nanie- --� <br /> Signature- Date-, <br /> Print Name: <br /> Date. <br /> Date- <br /> F-' <br /> ate:FiFgrrrs' C of <br /> Lo:Lisle At#ijstmentdoc_(Rtvist. <br /> I <br /> y <br />