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r <br />+ r nT LINE ADJUSTMENT <br /> f t SAN JOAQuiN couNTY COMMUNITY DEYELOPMENT DEPARTMENT <br /> • .:: . .. 77fOlZIZATlON sIGNAT,[IrtE'S � , <br /> ANIYTNr:o1NNPRbFTNi PftOPERTY6FtkrlpilrNQFtfZERIGENi`MAYFILEAN:APPLlCAfIbH, `. <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> t1,further, certify under penalty of perjury that 1 am(check one): <br /> i 0 Legal property owner(owner Includes partner,trustee,trustor,or corporate oMcee)of the property(s)involved In this <br /> application,or <br /> O 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 on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: '_��� C y1[/FF,(J Signature: L,4r Date: <br /> 1 Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />{ <br /> I <br /> I <br /> i <br /> • i <br /> f <br /> i <br /> i <br /> I <br /> I <br /> 10,01 AMPAJA98 FW--"1,1094 - <br /> -9- <br />