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�'-�' APPLICATION - LOT LI ADJUSTMENT <br /> 6i <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 3 <br /> FILE NUMBER: <br /> AUTO 'O Z 41wT1�l h N 1�EU'RES <br /> a3NILY 9'"T,0Wl4`9R OF THE,PRO__PERTY,QRiA y AI,JTH+D Z p AGENT§MAY FILE.=:AN APP_�ICATION:' <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: L]�`n_ `� 00.K Signature: Date:\0- 2.-<6-OA <br /> Print Name: a_ �.r� -� Signature: Date:\ - -a-Q"A <br /> Print Name' o.�l� '[ O�nl� _ Signature: Date:\'Z>-z5b-d`A <br /> Print Name: �� Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> F:0EVSVCT4anrting Application Fonns\ Paae 5 of 7 i <br />