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f <br /> � w <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> ' < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> . -. �: .,.... .-;. FILE NUMBER: <br /> RtFC3Rj <br /> �T 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, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> X Legal property owner (owner includes partner, trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> i <br /> i ❑ 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. <br /> Print Name: lqo � _ 7.` Signature: �'�� Date: � 1+ <br /> Print Name: �-+ y Signature: Date: <br /> Pant Name: ct <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> f <br /> s <br /> F:IDEVSVC1PIanning Application Forms% Page 5 of 7 <br /> Lot Line Adiustment.doc.(Revised 6-4-04) <br />