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- ° , APPLICATION - LOT LINE ADJUSTMENT <br /> < ENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> P 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 roe f <br /> $ property rty 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: G/s� $7 � <br /> Signature F6P;7--, Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> i Date: <br /> k <br /> FADEVSVC'Pianntng Application Formsl Page 5 of 7 <br /> Lot URB Adjugtmwt,doC.(Revisal 6-4-04) <br />