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h <br /> s l <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> <} SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 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. <br /> Print Name: 6;fkx ��"rj Signature: Date: `Z2`G <br /> . <br /> Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I - <br /> 4 <br /> `l <br /> F <br /> F <br /> 1 <br /> i <br /> FAD1:VSVC1P1wvmigllpplirnlions-ormsl Page 5 of 7 <br /> Lai Line Mjuslmeni.doc.(Revised 6-4-04) <br />