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y <br /> E <br /> a <br /> t - <br /> LOT LINE ADJUSTMENT <br /> 5AN JQAQLIIN COUNTY commuNI r'Y DEvELOPMENr DEPAR?MENr . <br /> A ' ORIZATIONSIGNATURES TH <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the Owner/Agent agree,to defend,lndemnlfy%and hold harmless the County and Ifs agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that 1 am(check one): <br /> O Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the-application of the property's Involved In this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Nome: MIMES ��. ,�ij�p"ff�cl7t� Slgrrtatu►wec �� c���"" '� Data: - 4f—: d-f <br /> Print Name: 1�f�J �. f �'9 -iVTZ7 Slgnatu bate: r p <br /> Print Name: G10iC I L. )�fL/yEi�%Ta ' Slgnature. Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> 1:41 PMPA_LA919 February 1,19199 <br /> -4- <br /> I <br />