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a0k- APPLICATION ® L®T' LINE l'IDJUSTtV1E1�1 Y <br /> ,.' .coG <br /> VJ!.■�1i�. < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .cP' FILE NUMBER.• <br /> %Fp N <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 /> I,further,certify under penalty of perjury that I am (check one): <br /> ® Legal property owner(owner includes partner,trustee, trustor, or corporate off icer)of the property(s) <br /> involved in this application, or <br /> XX 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 /> Ili Ili <br /> Print Name: DavinderS.Khunkhun(Owner/Agent) Signature: 4115-11s-- <br /> Print <br /> 1S 11Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSvoPlanninp Applicalion ForrnM Page 5 of 7 <br /> Lot Line Adiuslment.doc.(Revised 6-4-04) <br />