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h >�= APPLICATION - LOT LINE ADJUSTMENT <br /> 'ya <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Cf�oRt' <br /> AUTHORIZATION'SIG NATURES: � <br /> ONLY THE OWNER;OF:THE PROPER 6 D C <br /> TY.OR AN:AUTHORIZED AGENT MAY FILE <br /> AN-APPLICATION . <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 am (check one): <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. f <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 1 <br /> I <br /> F:OEVSVC1Planning Application Fosmsl Page <br /> 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />