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Qut" APPLICATION - LOT LINE ADJUSTMENT <br /> z: <br /> y� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •. ;P FILE NUMBER: <br /> I �fFOR� <br /> 9 <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT.MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and gold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the County arising from 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: Signature: Date/-a-9--/ <br /> Print Name: Signat Date: <br /> Print Name: gnatur Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> l <br /> FA)EV$VC\Planning Application Forms\ Page 5 of 7 #1097 <br /> Lot Line Adjustment.doo.(Revised 05-11-09) <br />