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APPLICATION - LOT LINE ADJUSTMENT <br /> r. = SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ills...'. <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 /> 9 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 /> / <br /> Print Name: l7e o e- F L u n4a 1'1 Signature: Date: %Z;0 <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature: Date:_ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: _ Date: _ <br /> F:k0EvsVcIP19nn1n9 Application Fonnsl Page 5 of 7 <br /> ,,.,� ..0"I. d, (Revised 05-11-09) <br />