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DocuSign Envelope ID:66FE80DA-AC90-4DDE-ADOA-3leO984FOA9D <br /> z;°P ��� APPLICATION — LOT LINE ADJUSTMENT <br /> s <br /> m: SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • c.. FILE NUMBER: <br /> �P <br /> 9(/PORN <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/Agent's project. <br /> I, 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 /> Wcu&gnM by <br /> Print Name: scottullravata Signature: k"ng°"AU Date: 9/18/2015- <br /> K19ECD85EAD/83_. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: _ <br /> F:10EVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doo.(Revised 05-11-09) <br />