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vAPPLICATION - LOT LINE ADJUSTMENT <br /> z.R. <br /> W i 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 /> [, the Owner/Agerit 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 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 fife o behalf., and that the foregoing application statements <br /> are true and correct. <br /> ��L � m � Date,Print Name:, <br /> Print Name: <br /> Signature: <br /> Print Name: Signature: te: <br /> k Print Name: Signature: Date: <br /> Print Name:, Signature: Date: <br /> F <br /> I <br /> 1 <br /> 1 <br /> f <br /> F:1DEVSVC0anning Application Formsl Page 5 of 7 <br /> Lal Line Adjustment.doc.(Revised 6-3-03) <br />