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PLICATION <br /> L�,+IE ADJUSTMENT <br /> ;.� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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, <br /> employees from any claim, action or proceeding against the Owner/Agent's project. officers and <br /> I, further, certify under penalty of perjury that I am (check one).- <br /> Legal <br /> ne):Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> e <br /> involved in this application, or P p rty(s) <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 f <br /> are true and correct. <br /> Print Name: <br /> Print Name: Signature: <br /> Date: 2 D7p <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: <br /> Date: <br /> Signature; ' <br /> Print Name: <br /> Date: <br /> Signature: <br /> Date: <br /> I <br /> FMEVSVC1Pianning Application Formsl <br /> Lot Line Adjustment.doc.(Revised 6-4-04) Page 5 of 7 <br />