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,i rt <br /> - _ <br /> 121 <br /> LOT LINE ADJUSTMENT <br /> SAN QEPAR tr <br /> OF ME PROPERIX Off AN -NTMAYEHXA12 AEELICATIOp4, <br /> t 1, the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,ofRcers and employees from any claim,action or <br /> i proceeding against the Owner/Agent's project: <br /> 1,further, certify under penalty of perjury that 1 am(check one): <br /> f <br /> Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> N Legal agent(attach proof of the owners consent to the application of the property's Involved In this application and <br /> have been authorl:ed to Rle on their behalf.,and that the foregoing appllcailon sfafements are true and correct, <br /> Print Name: 'V;OD Signature: Date:& <br /> Print Name: S)gnature: Date: <br /> Print Name: 'D-14&L , 7C•� tJ;� Signature: DaA06 1 103 <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> i <br /> s <br /> E <br /> l <br /> L� <br /> I <br /> f <br /> I <br /> h <br /> FIOt 5ER/IOARK/PLANAPP9/U]TLINlAO.IAPPFOAN RRV 2/1/99 -4- <br />