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f _ <br /> LOT LINE ADJUSTMENT <br /> 5AN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;aurtro�rrra no>Y s�Na r��r�s <br /> dNtY;77fOINNER,OFTEiEPIiQPLlZ7YOFl:1N/iUTNORl2EpEi1QlVT�HAXFIiEIINIiPPt1CA17pN:. <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> 1,further,certify under penalty of perjury that I am(check one): <br /> 0 Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved In this application and <br /> have been authorized to We on their behalf,and that the foregoing application statements are true and correct. <br /> Print Name: LY-J-41Signature: Date: g 3 U <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date.- <br /> Print <br /> ate.Print Name: Signature: Date: <br /> _q_ <br />