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� d <br /> 1 <br /> E LOT LINE ADJUSTMENT <br /> SRN JOA UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTNQRIZATION <br /> 9I6NATUF2I=S- <br /> NLY E WNER' . THE PR P T-y:QR'ANALPtkb&Zj6 AGENT M FILE A APPLICATION <br /> 1, the Owner/Agent agree, to defend,indemnify,and hold harmless the County and Its agents, officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that!am(check one): <br /> N Legal property owner(owner includes partner, trustee,grantor,or corporate officer)of the property(s)involved in <br /> this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: ' lir-i <br /> Signature: Date: <br /> Print Name: lYl _C <br /> -.e. r�� �_ a'' Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> a <br /> r <br /> I <br /> I <br /> I <br /> 1 <br /> F:DEVSER/IDARK/PLANAPPS/LOTLINEAD.IRPPFORII REV 2/1/99 -4- <br /> } <br />