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wry. APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;�• FILE NUMBER: <br /> �rFOR <br /> AUTHORIZATION SIGNATURES <br /> OI+PLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT WAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold hanniess 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 /> ❑ 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 /> Print Name: _Z-2 A R_V IR K k signature: Date: <br /> Print Name Signature: Date <br /> Print Name: signatime: 0,7 Da6a <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVC1P1 <br /> 2 <br /> nn1ng Application Forms\ Page 5 of 7 <br /> Lot Line Adjustrnent.doc.(Revised 64-04) <br />