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o <br /> ! <br /> LOT LINE ADJUSTMENT <br /> SAN JOA QUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i4UTH0R,7ATI0NSl6)4AT1RES . <br /> i� ONLYT f1E,OwNER OFTHE PROPERTYOR AN41T1i0RlZED AGENT mAY FILEAAt APPUCATION. <br /> �i 1,the Owner/Agent agree,to defend,Indemnity,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agenrs project <br /> 1 <br /> �l 1,further, certify under penalty of perjury that f am(check one): <br /> Legal property Yowner(owner Includes partner,trustee trustor,or corporate ofcer)of the property(s)Involved In this <br /> application,or <br /> t O Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and <br /> have been authorized to We on their behalf.,and that the foregoing application statements are true and correct. <br /> 1 E: <br /> Print Name: Rosamond Clark Signature; � Dare: 3_2—Aif <br /> Print Name: Robert Belmont Signature: pate: <br /> Print Name: �amq 1 'a Be l moLl t Signature: 10&AeW j7 IPA Date: --e?D <br /> l Print Name: Signature: Date., <br /> J Print Name: Signature: Date: <br /> f I< <br /> iE <br /> i. <br /> 4� <br /> P <br /> E <br /> E <br /> I� <br /> E <br /> i <br /> s <br /> I <br /> I <br /> i <br /> M ' <br /> l <br />} i <br /> i <br /> I. <br /> E` <br /> E' <br /> I. <br /> 1:41 PMPA LASE FeMuety 1.1999 <br /> —4— <br /> i3 <br /> f <br /> !i <br />