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LV 1 LILAC HUJUJ I MCIV 1 <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 6 <br /> ro ;'.. <br /> FILE NUMBER: <br /> L AU 1 MUK14A 1 IUN 11CaNA I UKtS <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENTMAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, Indemnity, 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 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: , Signature: �{ G�` Date: �f <br /> Print Name: _. -x[ f' signatur O k.o— Date:` II / <br /> i Print Name: Signature: Date: / <br /> Print Name: _ Signature: pate: I� <br /> Print Name: Signature: _ Date:- <br /> j1 <br /> F.'�EVT/CtPlancrng Application Fmirst Page 5 of 7 <br /> Lot line Adiustment.doc (Revised 05-11-0S) <br />