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°1�aq!N• AePLICATION — LOT LINE ADJUSTMENT <br /> N' %" K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> f . <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER'OF THE PROPERTY OR�`AN.AUTHORIZED-AGENT MAY FILE AWAPPLIC°AT" N <br /> I, the Owner/Agerit 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 that the foregoing application statements <br /> are true and correct. <br /> Print Name: Joseph V. Grijalva Signature: r r Date: <br /> Print-Name: Ruth A. Grijalva Signature: Date: S/1 U06 <br /> PrIM <br /> O - <br /> Print Name: Q��� Signature: _ Date: <br /> Print,Name: !! >N �lU�l`e% Signature: Date: D <br /> Print Name: Signature: Date: <br /> FADEVSVOPlanning Application Forms\ Page 5 of 7 <br /> Lot Eine Adjusiment.doc.(Revised 6-0-04) <br />