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v <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> ": =< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ° ,. W4� S . � ... <br /> 4 � 4X� „i <br /> wlm THI OWN R0F�-TIDE PRO.PEWY ORU4 #3AU i IORIZED iGI LVT MA'Y,t=1LE AlV_APPLII gTf41V.n;' <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 f-,egoing application statements <br /> are true and correct. <br /> Print Name: Joe P. Burns, Burns Family Trust Signature; Date: r j <br /> Print Name: Betty L. Burns, Burns Family Trust Signature: Date: <br /> Print Name: ltiL Signature: Date <br /> Print Name: L. L( _3 Signature: Date: <br /> Print Name: Signature: Date: <br /> 1 <br /> l <br /> I <br /> FADEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment doc.(Revised 05-11-09) <br />