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y - <br /> « c Y <br /> LOT LINE ADJUSTMENT <br /> - '- -' --"' -"--- -- SAN JO/1QUlN COUNTY COMMUNITY DEVELOPMENT DEPART"MENT <br /> AUl NORIZA TION SIONATURES <br /> Y Olt AN AU f NOPUEb AGENT'MAY r1tE AN Al•MICAt ION. <br /> 1,dill. f hi'rrrr/Aq4?r►!altrr•r!, !o rfp.lead, lndrrruHly, and hold harfnless fire Counly arrd I[s agents, officers and employees rrolq ally clalrn,acfloin'Jrrnrcerdfnq agalrrsf flrr.UWrlWA_grl)Us prn/rr.f. <br /> I <br /> 1, hrr(hcr', cerflfy Rnriar pnnaffy of/perjury flat l am(check nneJ; <br /> O legal propfloe,or ownrI-(oW)rer h)cludespariner, frers(ee, frusfor, orcorporade crMcer)offheproperty(s)Involved In fit <br /> nJ+Jrllcaflorr,or <br /> ajrnf(affach proof of fire ownpr's consenf to the applicaffon of(tin prep¢ y's Involved in fills npplfcaffon nnr <br /> � — hnve been authorlred to file an flrelrbehrrlf.,arrd Nrat the foregoing a llca sfa[emenis are true and correct. <br /> l*rint Name: ! <br /> ..--~---- .—�_----•_-_-- Slgrrafure: Vale: <br /> Pfill(Nall)): " <br /> - _ _ ---- - - S�yrrOff <br /> Uafe: <br /> Srgrratrlre: <br /> Date: <br /> f'rin[Na►rre: <br /> 5lgnafure: <br /> i'►!n[Nanro: Date:_ � Slgrrature: <br /> Vale: <br /> +x. <br /> s <br /> V <br /> P <br /> rpt riArn_ihoa rehmeq t,tsss <br /> a <br /> _4 Ip <br />