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AePLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPART ENT <br /> N T <br /> FILE NUMBER: <br /> I <br /> t <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FELE AN <br /> ' APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the Countyand its agents, <br /> f employees from any claim, action or proceeding against the Owner/Agent's pra officers and <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner Includes partner, trustee, trustor, or corporate <br /> involved in this application, or officer} of the property(s) <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 /> i <br /> Print Name: <br /> Date: r 0,5 <br /> Print Name: Signature: Dat <br /> Gi�� <br /> Signature; Date: <br /> Print Name: <br /> Signature: <br /> Print Name: Date: <br /> : ; <br /> Print Name: Signature: Date <br /> Signature: <br /> Date: <br /> FADEVSVOPlanNng Applkadon Forms% <br /> W une Adjus0wCdoe(Rev6W 64-04) Page 5 of 7 I <br /> I� <br /> .. _ I <br />