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F <br /> } _JT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEMOPMENT DEPAR MPNT <br />' AtJITNORIZA770N 310JH�1 <br /> I; <br /> G7tJRt5S _ <br /> `' OHL.'Y TH .:� tiff 3'ntE�IRbA�RTYOR AAS i4tlT�It11�fZE'b,4Ci�N7'AtAY�1/wEAN Ap,�►Lk!A{T�bAf <br /> ? 1 the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,ofticers and employees <br /> i; <br /> proceeding against the Owner/Agent's project p Y from any claim,action or <br /> I? <br /> 1,further, certIly uin_deer penalty of perjury that l am(check one): <br /> }� Legal property owner(owner includes partner,trustee,trustor,or corporate ancer)of the property(s)involved In this <br /> / \? application,or <br /> I <br /> O Legal agent(attach proof of the owner's consent to the application of the properiya Involved In this application and have <br /> been authorfred to file on their behalf.,and that the foregoing application statements are true and correct: <br /> Print Name: �411i Z, Signature: f Date:`v-21z-01 <br /> I <br /> Print Name: Signature: Date:Aq Z —O <br /> Print Name: Sig ature: Date: <br /> P Print Name: Signature: Date: <br /> I; Print Name: Signature: <br /> Date: <br /> i <br /> I <br /> i <br /> j <br /> I' <br /> q . <br /> � k <br /> I <br /> I <br /> �l <br /> I <br /> i <br /> I <br /> I <br /> M011 AMPA_L-M POhury 1,1101110 <br /> -4- 'I <br />