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1 <br /> APPLICATION - LOT LIN <br /> `K <br /> •'' ADJUSTMENT N MENTSAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE-NUMBER: <br /> ------------- <br /> � k <br /> r�yt'r'� �F `P 1 �'-. ��SIe° P-F aka is i �tb ',_v� + 3/�`.�"V � ,. s( -■■ <br /> y4.:t''} 3 { '� k hr�"7 3 -•r c � ,hn� �'t�,�,3 #^F �..:5dr�' RWJ�t 4a <br /> s1 <br /> }. r, `;m �'r a`;L',•y,2 3 i '�::,� C k "Y xs�'"'c, y r `.'y z '13 y� i�^a <br /> h - - <br /> '_Yi 14 KFE �.Y' ] P r' l�i�� ? '-i t J 4G;'': �r�,+^t�i 5'k1 4 it�i'T ,E�;,t'.r� X hf- 4 Y l i i-, •1 12 _' J bi �t <br /> 4_ TH P ORE 1 a�, HQ11DAxNtyaiLiQN ?� IGp►T,11tr <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and it agents,-.ofl•lcers and <br /> employees from any claim, action or proceeding against the Owner/Agent's protect. <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 theproperty <br /> involved in this application, or ) (s) <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: 0 e r Signature: , <br /> Date: Q <br /> Print Name; Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> k <br /> t <br /> I' <br /> F:IDEVSVC\PIanning APPlication Formsk Page 5 of 7 <br /> Lot Line Ad}ustment.doc.(Revised 5-3-03) <br />