Laserfiche WebLink
- ` ' APPLICATION - LOT LINE ADJUSTMENT <br /> y ' -SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT- <br /> 1 FILE,NUMBER <br /> R 1 <br /> 11 '{ <br /> Y 4: _ � ir'�a,;• � r,�;r -:Ear' t ti,,.r i�' �., WYi� ,� P -i; 5. � ,fie., �, �.-�fyy.' L xy ti � y.J <br /> •ice ¢� � <br /> .I, the`Owner/Agenf_ agree, toafantlr.fnde�rinify, and hold fiarnless;the County and its agents, officers;and ? <br /> empioyeeSO ro-rm a,h yV cl61m, actitlr:or pro eding-against"the Owner/Agent's project: �* <br /> I, further, cer#ify under penaltyof penury that I:am (check one)'' s t k <br /> t :. <br /> Legal property owner'(owner ,includes partner, trustee, trustor,`or,corpora a of d;or) of the property(s) <br /> ` :. 'involved iris apPii14 <br /> cat�on; or N t 1A :rx <br /> f the ownet s <br /> ❑ I_egat agent.(attach proof oss.consenttoS. the application of the property's involved ('.this <br /> application and have been authortzed tosfileon-tne'ir,behalf:, and that the foregoing application statements <br /> are true and correct.. ' <br /> Print Name: . 11� Signa Date: -U� <br /> Print Name: " Signature: ' <br /> AV. g _ �.c.-r.N Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature:. <br /> Print Name: { Signature: t Date: <br /> F : <br /> F:IDEV$VC1Ptanning Application Fonnsl Page 5 of 7 <br /> Lot Line Adjustment-doe,(Revised 63-43) <br />