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APPLICATION LOT LINE ADJUSTMENT <br /> y y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTNI <br /> :r ENT ,. <br /> FILE NUMBER: <br /> �AUT�QT�QN <br /> - <br /> ONLY THE OWNER 4F THE'PROPEKIYOR AN 1100ORMED.A6EjV1'fiAi�►YC F1tt=;qy p�pPLICAT10 i1 <br /> the Owner/Agent agree; to defend; indemnify,=and hold [baimless'#he Eoun#y Arad its agents, gffioers aril <br /> Y Proceeding 9 <br /> employees from an claim action ora airist the Owner/Agent's,project_ <br /> I, furt r, Certify under penalty of perjury that ! 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 /> 0 Legal agent (attach proof of the owner's consent to the appficatian of.the property's involved,in thin <br /> application and have.been authorized to file on_"�ieirbehaff.; and.t at the foregoing application statements <br /> are;true and coned., <br /> ti <br /> Print Name: ; Signature: ~' <br /> ,.Date: o <br /> Print Name: Signature: <br /> Date: <br /> Print-Name: Signature: <br /> Date: <br /> Print Name Signature: <br /> Print Name Signature: <br /> Date: <br /> i <br /> FADEVSVCPlanning Application Formsl Pagt3 Jr of 7 <br /> Lot tine Adiustment-doc.(Revised 6-3-03) . <br />