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a4�t . APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> e .. 1 FILE NUMBER: <br /> ct�:oe <br /> 3 <br /> A. UTHORIZATION SIGNATURES'° _. <br /> ONLY <br /> THE:0WNER O.F.THE PROPERTY OR:AN AUT:HORIZED.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. i <br /> i <br /> I, further, certify under penalty of perjury that I am (check one): I <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: ��� pR5SA�� I A Signature: Date: <br /> Print Name: Cir �� C.. ':t, Signature: .^e..ngs.� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> F:\DEVSVCkP1annin9 Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doe (Revised 6-4-04) <br />