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¢u.Sry. <br /> ` APPLICATION e LOT-LINE ADJUSTMENT <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN AP7ne <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agent <br /> employees from any claim, action or proceeding against the County arising from the Owner/Age <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 pro <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved application and have been authorized to file on their behalf., and that the foregoing applicatio <br /> are true and correct <br /> Print Name: -J Kt/ ' IZ <br /> Signature: •� i' <br /> Print Name: <br /> Date: <br /> Signature: <br /> Print Name Date: <br /> Print Name- <br /> Signature: <br /> Date: <br /> Signature <br /> Print Name: <br /> Date: <br /> Signature: <br /> Date: <br /> 'iDEVSvMPlanning Application Formm Page 5 of 7 <br /> of Line Adjustmentdac (Revised 05-11-09) g <br />