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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> g � '� � y, U<TdRf A, rSl { ? T# � v <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 /> f,further, certify under penalty of perjury that I am (check one): <br /> f ® Legal property owners (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> h ❑ 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 /> I' are true and correct. <br /> Print Name: �l --• Signature: Date: ZZ <br /> Print Name: L)40.0-A40 te.11 L_._ Signature: Date: 22--a 3" <br /> Print Name: Signature: Date: <br /> Print Name: Signature, Date: <br /> Print Name: Signature: Date: <br /> i <br /> 1 <br /> 1 <br /> i <br /> FIDEVSVCIPIanning Application Forms\) Page 5 of 7 <br /> Lot Line Adjustment.doc {Ftevised 6-04-04 <br />