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F {� <br /> b r <br /> f F SSj 3r <br /> LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AllTHOR1ZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTNORI2FD AGENT MAY FILE AN APP <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> ar proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that l am(check one): <br /> 0 Legal property owner(owner includes partner, trustee,trustar,or corporate oflicer)of fhe property(s)Involved In this <br /> application,or <br /> 0 Legal agent(attach proof of the owners consent to the applica n f the props involved In this application and <br /> have been authorized to file on their behalf.,and that the fo oIng p [cation <br /> ants a nd correct <br /> Print Name: D, <br /> Print Name: Date: <br /> Signature: <br /> a <br /> Print NamDate: <br /> e: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date. <br /> Print Name: —�— <br /> Signature: <br /> Date: <br /> I <br /> I <br /> i <br /> • i <br /> I <br /> i <br /> i <br /> s <br /> I <br /> f <br /> 1M1 PMPA_LA"Fet ary 1,1485 ' <br /> i <br /> -4- i <br /> I <br /> } <br /> I <br />