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fs <br /> � �ulN APPLICATION - LOT LINE AD <br /> JUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> ��<1a o ''`p• FILE NUMBER: <br /> , <br /> � Al���'HOI�IZAT101V�SIGNAT_UR.ES,`,�` .... <br /> 'ONLY THS OWNER O1F THS PROPERTY OR AN`AUTHORIZED'AG € :»: ' i .. <br /> .. <br /> ENT.MAY.FILE AWAP,PLICATION. ' <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 County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> i <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: f- �Or�'1�7rrl Signature: r <br /> // Date: �z i�n <br /> Print Name: `'N� b �a ; Z,Cn�� Signature" Date:?: lG <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> F:0EVSVMPlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05.11-09) <br />