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k f + k <br /> r- - APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ONLY THE OWNER OF,;THE PROPERTY OR AN AUTHO <br /> RIZED:AGENT MAY'FILE AN APPLICATION <br /> I I, the Owner/Agent agree, to defend, Indemnify, and hold harmless the County and its agents, officers an <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 /> 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 statement <br /> are true and correct. <br /> Print Name: /}, ,� tah Signature: Date: - 4 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> t <br /> FMI)EMCUlanning Application Formsll Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />