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L T LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORISATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTYOR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the OwnedAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,Officers and employees from any claim,action or <br /> proceed/ng aga/nst the Owner/Agent's project <br /> 1,further, cert/ly under penalty of perjury that 1 am(check one): <br /> O Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s)Involved In this <br /> 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 have <br /> been authorized to file on their behalf.,and that the foregoing application statements are We and correct <br /> Print Name: ' '/ - �• SBI'— Signature: /�"U�L� �s ,Lfur Date: <br /> Signature: <br /> Pn'nt Name: ,1d1�_ Signature: �.r-/, a ��- `- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> io:m.Wpn uva F.w.ry,.,aeu <br />