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iZ. <br /> • - N <br /> f <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "9 <br /> FILE NUMBER: <br /> -------------------- <br /> AUTHORIZATION <br /> ----__ <br /> }� __— -- <br /> I <br /> 1 <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 /> 1, 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 th property's involved in this <br /> application and have been authorized to file on their beh ., and that a foregoing application statements <br /> are true and correct. <br /> Print Name: V Signature: <br /> Print Name: Signature: Date:_—,____—_---_ <br /> Print Name: Signature: Date:______________ <br /> Print Name: Signature: Date:----- ------- <br /> Print Name: Signature: Date: <br /> F%DEvsvc\Flanning Application Form sl Page 5 of 7 <br /> Lot Line Adtuslment.doc.(Revised 6-4-04) <br />