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°P0.u! . APPLICATION - LOT LINE ADJUSTMENT <br /> �.•.��.coo <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ilJ; ;K <br /> . c... _-.�.. a• FILE NUMBER: <br /> AUTH <br /> DRIZATIORL&GI�ATURES <br /> ONLY TH.E GINNER OF THE PROPERTY OIC 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/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. 11 <br /> Print Name: 1 .5 Signature: Date: ��•30--0 b <br /> Print Name: _ Signature: Date: 1.2 —Z.�� <br /> Print Name: Signature: Date:1L—/.S—ef, <br /> Print Name: Signature: 74` Date: <br /> Print Name: Signature: Date: <br /> I <br /> FI)EVSVOPlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustmeni.doc.(Revised 6-4-04) <br />