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.tr- r � o � • v 'i:�E::ii4r, 0�r� <br /> ♦ , ' 21 <br /> s- LOT LINE ADJUSTMENT. <br /> SAN JOAQWN COUNTY COUXUW"DEVELOPMENT DEPARTMENT k,i <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAYFILF AN APPLICATION. <br /> 1,the Ownen'Agenf agree,to d*IWA,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agenes 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)Involved In this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the applkation of the property's Involved in this application and <br /> have been authorized to We on their behalf,.and that the foregoing application statements are true and correct <br /> Print Name: yo U-1{ Signature: Date: -Z-2- <br /> Print <br /> ZPrint Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date.- <br /> Print <br /> ate:Print Name: Signature: -_. .__.. Date: - <br /> k <br /> i <br /> I: <br /> -{rr <br /> 1.41 PWAJAIS FsbrwF 1.1999 // , <br />