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A t � <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT. <br /> i�•. i4 FILE NUMBER: <br /> NNUM 600. . AUTHORIZATIDN SIGNATURES <br /> ONLYTHE;;OWNER,.OF�THE PROPERTY,.ORAN AUJTHORIZEDAGENTtMAY.FILE.AN,APPLICATION. <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. p <br /> Print Name: BLAINE DEJONG, TRUSTEE Signature: Date: I <br /> Print Name: Signature: d Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: j <br /> i <br /> I <br /> Print Name: Signature: Date: !I <br /> k <br /> f <br /> ' 4 <br /> I <br /> I <br /> i <br /> RTEVSVCTlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />