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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FII.[ NUMBER: <br /> EM i <br /> 3 <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> 1,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 Owner/Agenrs project. <br /> I,further,certify under pprialty of perjury that I am (check one); <br /> ® Legal property owners (owner inrludoe partner, trustee,trustor, or corporate officer) of the properly(s) <br /> Involved In this application, or <br /> Legal agent(attach proof of the owner's consent to the application of the propertys involved in this <br /> application and hove been authorized to file on Ihalr behalf, and that the foregoing applicoGon statements <br /> ere true and coRBCL <br /> Print Name: Slqnature7 DaW 2-22-06 <br /> PrInt Name: -A41 Si nature: Date: <br /> Print Name: Si nabire: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Si nature: Date: <br /> F?D6vev'Tienrino Aoml=oon r-ormot) Page a of 7 <br /> l.at Linn Mlui"&nt.dnc(ReAsad 6434_04 <br />