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f <br /> PLICATION - LOT LeM ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . .; FILE NUMBER: <br /> S <br /> _ Ivr <br /> L <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 Owner/Agent's project. <br /> 1, further, certify Lander penalty of perjury that 1 am (check one): <br /> f Legalpropertyowner (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: LEE KELLER Signature: Date: 5-- <br /> Print Name: Signature- Date: <br /> Print Name: Signature: Date: <br /> f Print Name: Signature: Date: <br /> Print Name: Signature: Date: . <br /> i <br /> i <br /> i <br /> I <br /> i <br /> DEVSMPlanning Application Forms\ Page 5 of 7 <br /> j 1 Line Adjustment.doc.(Revised 8-4-04) <br />