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I <br /> �I <br /> Y APPLICATION - LOT LINE ADJUSTMENT <br /> _ : .. <br /> SAN JOAQU'IN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT II <br /> N; <br /> FILE NUMBER: I <br /> I <br /> I <br /> - I <br /> AUTHORIZATION SIGNATURES l <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 /> trustee,trustor, or corporate officer)of the property(s) <br /> Legal property owner(owner includes partner, <br /> Involved in this appiloation, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's Involved <br /> In statements <br /> n this <br /> application and have been authorized to file on their behalf., and that the foregoing appIl <br /> are true and correct. <br /> Print Name: Lo";.s S 055 Signature: <br /> — <br /> Print Name: <br /> Slgnaturo: Date: <br /> Print Name! <br /> Signature: Date; <br /> PYlnt Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> I <br /> I <br /> i <br /> I <br /> i <br /> FADEVGVW1cmmng Applloation Format Page 5 of 7 <br /> Lot Lina AdNalmenLdM(Rowled 06-11-N) <br />