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k <br /> LT LINE ADJUSTMENT <br /> 5AN JOAQuiN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUINOA ZAtlN 31GNA71!(t�$,.. <br /> ONLY <br /> 7NL�041/Nl ft OF TN .IiROl EAt Y UF2 AN AUiNb#bZE'b,A*9NTMA I`P1L L AN �IpP11CA7lON:: <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or , <br /> proceeding against the owner/Agent's project <br /> 1,further, certtfy under penalty of perjury that I am(check one): <br /> a Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> application,or <br /> O Legal agent(attach proof of file owner's consent to the application of the propertys Involved in this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> i <br /> }} 1f f <br /> Prfnt Name: J h h �',/��m r L �/l S_ Signature: N�, 1/ fi�� Date: 7- 3 <br /> Date: <br /> Print Name: Signature. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: 1 <br /> i <br /> i <br /> i <br /> i <br /> i <br /> I <br /> E <br /> IM FM AJA9a Fabn y 7,7989 <br /> if <br />