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"gu`" APPLICATION — LOT LINE ADJUSTMENT <br /> ,o.' ".roti <br /> yt SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; <br /> •.-� P-. FILE NUMBER: <br /> 4(IFO(RN\ <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 and correct. 6 <br /> Print Name: -Q1Y 61ZI EF� Signature: Date: `�` o' �L <br /> Print Name: �Q/N 60IFR714 Signature: Date: <br /> Print Name: (5�R/ 9='rr74 Signature: Date: "Z Z- <br /> Print Name: rEDD)E M. BLA- l4-6=— Signature: Date: a �z <br /> Print Name: W lGUE W, 64PIEFITY Signature: Date: <br /> F:\DEvsvmplanning Application Forrns\ Page 5 of 7 <br /> Lot Line Adjustment.11M.(Revised 05-11-09) <br />