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APPLICATION - LOT LINE ADJUSTMENT <br /> a SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> a: < <br /> FILE NUMBER: <br /> •I F.•:R <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 /> 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 /> Signature: Date: 60Z__7 13. <br /> Print Name: l�K2lS-CIIPK�"n 1'C<� <br /> Print Name: (SLC. Signature: Date: <br /> Signature: Date: <br /> Print Name: Date: <br /> Print Name: Signature'. <br /> Date: <br /> Print Name: Signature: - <br /> Page 5 of 7 <br /> F.\DEVSVC\Plannirg Application Forms\ <br /> Lot Line Adi,,tmant.dcc.(Revised 0571-09) <br />