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_OT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLYTHEOWNEROF THE PROPERTYOR AN AUTHORIZED AGENT MAYFILE AN APPLICATION, <br /> 1,the OwneNAgent agree,to defend,Indemnify,and hold harmless the County and Us agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,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)Involved In this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: 17htOt�il C�. CHIC(�I�� Signature: i �-__— Date: <br /> PZ12c <br /> Print Name: ( _c-�,r,5 t c,<�1 .. L -,c Signature: C Date: t i•t 2 ii <br /> Print Name: E I)M GN 9 el. Signature: Date: /'L zo <br /> Print Name: crus Signature: - _. _ . Z ._.� Date: i j c I <br /> Print Name: Signature: Date: <br /> 10.038 PA U FW 1.1WR _ <br /> _g <br />