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i <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> J. <br /> �i <br /> FILE NUMBER: <br /> iii=owe'' <br /> AUTHORIZATION SIONATO.RES <br /> ONLY THE OWNER OF THE PROPER'MORANAUTHORIZE0AGENT 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 /> I, further, certify under penalty of perjury that I am (check one): <br /> XQ 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 /> I <br /> Print Name: L �lt(.•! Signature: - Date: <br /> Print Name: �r y.. . �}ilf�:#�,,1 ti7 Signature: Date: /'�) <br /> Print Name: Signat e: t Date: [ � ©t <br /> Print Nam I'idc 1¢�( t Signat, (e— `�` , G� ! <br /> Date: / <br /> Print <br /> Name: Signature: Date: <br /> 4 <br /> FADEVSVC1PIanningAppfication Formsk Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-3-03) <br />