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GpA1 ^I <br /> R�ll , i _ <br /> ' APPLICATION - LOT LINE ADJUSTMENT <br /> i0 F :K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> s <br /> fi: ;�� FILE NUMBER; <br /> AUTHORIZATION,SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY'OR AN.AUTHORIZED AGENT-.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 /> 1, 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 statements <br /> are true and correct. <br /> i <br /> Print Nam Signature: Date: �(P <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name. Signature: <br /> Date: <br /> I <br /> Print Name: Signature: Date: <br /> I� <br /> i <br /> F:IDEMMPlanning Application Forms% <br /> Page 5 of 7 <br /> Lot Line Ad}ustmenttloc.(Revised 8-4-04} � <br />