Laserfiche WebLink
op4�tH� APPLICATION - LOT LINE ADJUSTMENT <br /> ENT <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �4�S�kai'�'• FILE NUMBER: <br /> - AUTHORIZATION SIGNATURES ONLY THE OWNER OE;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 l 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: © GlCe QS" Signature: <br /> Date: <br /> Print Name: Signature: <br /> > Date: <br /> Print Name it I h Q Signature: ii r.-.l `x, ` <br /> Date: <br /> Print Name: Signature: <br /> - Date: <br /> Print Name: Signature: <br /> Date: <br /> F:IDEVSVQPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Rev,sed 05-11-09) <br />