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in <br /> L <br /> APPLICATION -- LOT LINE ADJUSTIVIENT <br /> :rte' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> V. 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, offloers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1,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 properly°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 /> Signature: <br /> Date: ��18 ✓ <br /> Print Name: 9 <br /> '�Jl' ' nature: Date:Print Name: ( - I <br /> Print Name: /' bac-W' -r-V L-X P t' S Signature: l� ---^- Date: 1 <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> F:\DEvsvcIPianning Application Forms\ Page 5 of 7 <br /> Lot Line Adiustment.doc.(Revised 6-3.03) <br />