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°R ~�� APPLICATION — LOT LINE ADJUSTMENT <br /> 2:. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • .., m Cp� FILE NUMBER: <br /> )FOR-N <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 County arising from 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: To&I TCCkIL11 &!2y Signature• ` (�-1 Date: <br /> Print Name: Lee- Tr'f��h vTib Signature(.:--& ���"� � Date: �-- <br /> Print Name: f) Ati. Jes L A)ohC�� Signature: �/�� Date: <br /> Print Name: L-ak uC'k� 3• A V o4-C L Signature: �7�p(�D� va Date: <br /> Print Name: Signature: Date: <br /> F:IDEV OFUnning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustmentdoc.(Revised 0611-09) <br />