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LOT LINE ADYUSTMENT <br /> 0SANJCOMMOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Rth-oneMg.nt agree, to defend,indemni $ " <br /> fy,and hold harmless the County and its agents,officers and employees,from any claim,action r.. <br /> or proceeding against the Owner/Agent's project. <br /> 1,further,certify under penalty of perjury that 1 am(check one): <br /> X Legal property owner(owner includes partner, trustee, trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> i <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have <br /> been authorized to file an their behalf,and that the foregoing application statements are true and correct <br /> i _ � <br /> Print Name: �`� <br /> S' nature: u / .3 <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature, <br /> Date: <br /> i <br /> -4. <br />