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'- - - PLICATION - LOT LJE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • ; FILE NUMBER: <br /> _ Y <br /> E <br /> 4 <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 /> 1, further, certify under penalty of perjury that 1 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 /> F1 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: LUETRICZA KELLER Signature: Date:c5 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Dake: <br /> Print Nome: Signature: Date: <br /> Print Name: Signature: Date:. <br /> k <br /> i . <br /> DEVSMPIanning Application Forms\ Page 5 of 7 <br /> Line Adjuslment,doc,(Revised 6-4-04) <br />