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°� c�� APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4�/FORa\ <br /> c".�r.. FILE NUMBER: <br /> 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 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 foregoing application statements <br /> are true <br /> /and correct. ` <br /> Print Name: Signature:X Date:/! ' L$' 16 <br /> Print Name: / Signature: / q Date: <br /> Print Name: AP'10 U\ty 60,44,J4Ll 'ISignature)(4 h �O h 1 0G D�2A(L= Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Appiicatlon Fonns\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05.11-09) <br />