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=F` APPLICATION - 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 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 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; 1 Signature; Date: 9 <br /> Print Name: Signature: q i <br /> pate: <br /> Print Name: // e'I /'/G 4ncw<LSlgnatu 6' Date: g <br /> Print Name:�TP✓C!7 ( U/•Ji c�p�Q y^a� •_ Date: <br /> Print Name: - Signature: Date: <br /> RVEVSVMa irg Appipdon Form % Page 5 of 7 - <br /> LOtuneAd)ustmenWW.(Revised 0.411-09)_ _. <br />