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r , <br /> n'APPLICATION — LOT LINEADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> I� Y3 l`S yYqk�' >S - `,�g�._-2 • v: _ }� r; UR ESP <br /> Y,r 1`t �yt- ,» 'F+ ter i k <br /> ,.O.N .1rTR�aQF T ti _ li-I ��Aj hT fFl t � <br /> .. <br /> I, the Owner/Agent agree, todefend,` indemnify, and hoid Harmless the,County and its agents, officers and <br /> employees from any claim, action or proceeding against the OwneNAgent's project. <br /> 1, further, certify under penalty of perjury that I am (c'he'ck one): <br /> ® Legal.property owner(owner includes-partner, trustee;trustor,-or corporate officer) of the <br /> 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. i <br /> Print Name: J off►. . ierke 'Signature: —r cA .n Date: 2 0 10 4 <br /> Print Name:L�i�r �e U0ca6ic.r"—S* <br /> Signature:- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> nevsyclPianning APPNcatlon Formai Page 5 of 7 i <br /> I tiKe Adiustmentdm(Revised 6_1W3) <br />