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,..k <br /> LOT LINE AD JUSTpMENT <br /> 11::tLy THE ers and employees from any clam,action or <br /> i,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,offic <br /> proceeding against the Owner/Agent's project <br /> 1, further, certify under penalty of perjury that!am(check one): <br /> Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)involved in <br /> O eg p <br /> this application,or <br /> Legal agent(attach proof of the owner's consent to tha application of the property's Involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing appllcatlon statements are true and correct. <br /> 6� nate: <br /> e • / Signature' <br /> Print Name: <br /> Date: <br /> Print Name: <br /> Signature: <br /> Date: <br /> Print Name: <br /> Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> l <br /> i <br /> l <br />�I rx - ... _ '��.T�r�M�.�1�alarr a+wrs�� �wwr�-,.wr - -�:;ar_-"_ ,,;..�,;�4►. -w+....... <br /> F.DLVlER/IUARK/FWKAPPL/LOTLINLAWAFPFORN REV 2/1/49 "4' <br />