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I 1 <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> f'FraRT'ia FILE NUMBER: <br /> - :. ,,� .� _QRtlQT� �.r., ��°►.�T�RE3. � � k x � � <br /> AUTIO�IZED, G . <br /> 1. TSQWNERQ �T EPROP ,{$ <br /> _ ENTMA, FILES�i�PPLC/AMIO <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: Joseph N- „F„j, 1 i P�� l l i Signature: Date:�Q(\ Clg� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> f <br /> E <br /> FADEVSMPIanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 84-04) <br />