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y f r jj <br /> APPLICATION' N -- LOT LINE ADJUSTMENT <br /> f SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _R a FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <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 t t the foregoing application statements <br /> are true and correct. <br /> Print Name; VI6 Signature: 4 Date: <br /> Print Name: G 4 Signature: Date: <br /> Print Nem t� Signature: (! �� (�� <br /> Date: <br /> print Name: Signature: <br /> Date: <br /> Print Name: Signature: Date; <br /> I <br /> ii <br /> • I <br /> F,,ZEVS/CTtanningApptication porMSk page 5 of 7 <br /> Lot Line Adjustment,doc.(Revised a4-44) <br /> JTInT 7G1H-1 MIT A']Aunc eTKIH'l _iOnL.IC 7JOTCCCCrl7 i,C•'CT QnM71J 7ICO <br />