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APPLICATION -- LOT LINE ADJUSTMENT <br /> r _ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> 7��N� <br /> AUTHORIZATION NATURES <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 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 /> Print Name: ` C <br /> ' �`';. ;---�-'��Cl� Signature: �-_._ -• �-fz�-�' x_':,. '15.-;—�=:' Date: <br /> Print Name- Signature. Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F FC EVSVC',Planniny AppJ-Wion Forn3si Page 5 of 7 <br /> Lut Lirn?Adjuslme:,l oc.jRevic rol 0-4-47.1 <br />