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N <br /> N <br /> K APPLICATION _ LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY <br /> DEVELOPMENT DEPARTMENTf _ ti <br /> fkQ ' FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ffONLY TH!"OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATiQN. <br /> 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 props s <br /> involved in this application, or property(s) <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved <br /> application and have been authorized to Fife on their be to this <br /> are true and correct. at the Foregoing application statements <br /> Print Name: <br /> Signa Bate:�-ZQ <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Ih <br /> Signature: <br /> Print Name- Date: ` <br /> Signature: gate: <br /> Print Name: I <br /> Signature: I <br /> Date: i <br /> i <br /> I� <br /> 1 <br /> P <br /> 1 <br /> h <br /> ,E F:}b£VSVOPlarming Appliminn Formal Page 5 of 7 <br /> Lot Lino Adjuslmerd.dec.tReviOed 5-6,041 <br /> I. <br /> _ I <br />