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V s <br /> APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c;Fid; FILE NUMBER: <br /> AU.THORiZATtON° IGIAURES. <br /> a.NI Y.' °atNNE'R o rHI P P» RrY o�AN AW7HO G <br /> DAGENT MAY FILE.- PLlCATION. <br /> I, 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 /> 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 Name7 signature: ofilDate:2,�23 Zo,,o <br /> Print Name: Signature: <br /> Data: I <br /> Print Name: Signature: Date: 'oq <br /> Print Name: tO�SMZ-a Signature: Date: <br /> Print Name: Signature: Date: <br /> 3 <br /> I <br /> i <br /> FADEVSVCIPIanning Application Formal Page 5 of 7 <br /> Lot Line AdjuetrnenLdac.(Revised 84-04) <br />