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APPLICATION - LOT LINE ADJUSTMENT <br /> CA4 <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 County arising from the Owner/Agents project. <br /> 1,further, certify under penalty of perjury that I 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 /> L` <br /> Print Name: \ CI r t.a'+ e— ! Signature: V Y Date: 9-2--i-i <br /> • -� <br /> Print Name: �_ 2 R 944 �s. S h7e I1 loll Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: iLLCP h e �- �tJ Signature: 0 LAA Date: E� <br /> L�L�-1'h a i Z� P✓I't <br /> 5 O 0 <br /> 19 .i?� � oc `E Q GC� Q17 0 u12 e � 1 a SGb /r7i� <br /> Qh � L1C0. on {(-3R a L,L _1q, avid a k-n0p S 1eGai cteSCRiP- <br /> iDhs '� o `hh Qbo )e. qk, Pie) n 4 <br /> P0.+e.l ae5 300 - 03 S I`e -- <br /> T� <br /> F:0EVSVC\P1anning Application Formal Page 5 of 7 <br /> Lot Line Adjustmentdoc.(Revised 08-11-09) <br />