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.. _ <br /> Ot <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �fFO <br /> �;• ya <br /> spa - <br /> aNLY� HI��['�'�►N��'�C)��"f1 P�;��„�R'f"Y��R4��f CJI;UTH��i���,��`�I�T�1�'lhl��I�,fL� <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 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: _4 4 ZIIA"S►y 42"fer— Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> a <br /> I <br /> I <br /> FADEVSVCIPIanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.{Revised U5-11-08} <br /> r <br />