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N I <br /> Wet. APPLICATION LOT LINE ADJUSTMENT <br /> a` X SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _N,r FILE NUMBER: j <br /> •�•R <br /> s <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 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: �p� ��p�� Signature: r Date..1'e?-S-ZyOg <br /> Print Name: Signature. Date: <br /> Print Name: Signature: Dake: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> POEVSM131anning Application Fonnsl Page 5 of 7 <br /> Lot Line Adjusiment.doc.(Revised 84-04) <br />