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1 l <br /> -mac° APPLICATION - LOT LINE ADJUSTMENT <br />' _: a •G <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION .SIGNATURES <br /> ONLY THE OWNEWOFTHEPROPERTY OR AN,AUTHORIZED°.AGENTMAY 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 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. arjd that the foregoing ap lication statements <br /> are true and correct. <br /> Print Name: Gt!! Signature: Date: f rO <br /> Print Name: Signature: Date: <br />€ Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> k Print Name: Signature: Date: <br /> i <br /> F:1IDEVSVDPlanning Apps>cation Forms\ Page 5 of 7 <br /> Lot Line Adjustment-doc.(Revised 6-4-04) <br />