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P r <br /> gid" k)PLICATION -- LOT CJE ADJUSTMENT <br /> u4ie6 <br /> •tw <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> oil <br /> & <br /> 2'a V011i NINEp. <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 /> I, 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) <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: CAROLYN KELLER nature:Si <br /> 9 ��P � Date. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: . <br /> DEVSVCIPIanningAppr::cation Formsl Page 5 of 7 <br /> t Line Adjustment,doc.(Revised 6-4-04) <br />