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` APPLICATION LOT LINE ADJUSTMENT <br /> w <' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> Iva- <br /> ONLY THE Otd NER OF THE PROP r iE ESR AN AU`SHt?i�ll��}AL3t�'1'.iR ) FIL AN APPI:.ICATI[3N. <br /> J, the OWF%er/Agent agree, to defend, indemnify, arid hold harmless the Covity=and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further,'cerfify order penalty of periury that I am {Check <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> inVoived in this application, or <br /> h.e.,..... -hy.� �.Y q, p--..�.y_. �..,.,...LL.res: <br /> ET�Legal agen (attaar+ goof�of tfie owners consent to the applicati0 of the property s rrivolved in this <br /> application and have been authorized to file on their behalf., Prid that therforegoing application statements <br /> are true and correct. <br /> Print Alarre:" _ � .�LCa1 Signature: _ Lags: <br /> C <br /> Print Dame: YQ 1'c C� Signature: LV Date:_��_Q!�__. <br /> Print Name: '� _ Signature: _ Hate: <br /> x <br /> Print Name: {- �,! ' t ;;ignatr,re: r Date: <br /> Print Name: -------.------------ _ Signature: _ _ _ Date:_ <br /> j <br /> F 10EVSVC1,P!W16ng rorrns� Page 5 of 7 <br /> Lot Line Adiost nent.dry:. 'Reosed E,-3.0v; <br />