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.:.� Ar'PLICATION - LOT LINE-ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> O [ON SIG <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZEDGENTMRY FILE AN APPLICATION - <br /> 1, the Owner/Agent agree, to defend, 'indemnify, and hold harmless the County and its agents, officers an <br /> employees from any claim,action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 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 statement <br /> are true and correct. <br /> Print Name: <br /> J �r <br /> n/ L G Signature: Date: <br /> Print Name: ;c �, Signature: <br /> Date: : l - I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> t <br /> F:1IDEVSVC\1PIann1ng Application Forms\\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />