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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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 County arising from 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 owners 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 trues and correct. <br /> Print Name: Reba47 E 140cts� Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> � 18� - l00 - l2 ,D<s � ereb�( Q;[le Yr�Lf <br /> Co h sen �- �bg e>7e 1- �acu f'o c c,4 © . V be had <br /> fi cA-6 »i ah a.+i in a L , L . A ) cine a mq <br /> 1e0( 1 escl' r` Af ;anS -1-0 -Fh <br /> o cZ h0 O-I�feR ou.R 'POS� , <br /> Ro bert Morris I8 -rdo - �I f. GAP 2 <br /> Eoberorrr' S ! �3 - !ca®- !2 5rPaL <br /> FADEVsvopianning Application Fonnsl Page 5 of 7 <br /> Lot Line Adjusenent.cim(Revised 05-11-09) - <br />