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1 <br /> ` .: t�tJPLICATION - LOT LINE'ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION R <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 an <br /> employees from any claim,action or proceeding against the Owner/Agent's project. <br /> li <br /> I, further, certify under penalty of perjury that I am (check one): <br /> it <br /> N! Legal property owner(owner includes partner,trustee,trustor,or corporate officer) of the property(s) <br /> u 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 /> i; application and have been authorized to file on their behalf., and that the foregoing application statement <br /> are true and correct. <br /> !i <br /> Print Name: Randall Lange signature" 'l Date: �P/A <br /> Prin!j t Mame: Bradford Lange Signature: Date: 7 <br /> - <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Y <br /> k <br /> ii <br /> K <br /> ii <br /> t <br /> f ' <br /> FA\DEVSVC\\Planning Application%rmsl\ Page 5 of 7 i <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br /> EE, j <br /> fl. ! <br />