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f <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �' FILE NUMBER: <br /> i. <br /> AUTHORIZATION SIGNATURES <br /> ii <br /> ONLY THE OWNER';OF THE PROPERTY OR AN AUTHORIZE©AGENT MAY FILE AN APPLICATION. <br /> ;r <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. <br /> further, certify under penalty of perjury that I am (check one): <br /> penalty <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 /> s <br /> Print Name: EPt t7A-Zb V AA1 DI 6M 9h/ Signature: - Date: 2 <br /> f <br /> Print Name: �V��)!`C�` vf�/�f Signature: s �.�•�;�C ��� �� Date: ' !; j <br /> Print Name: ��L I�1� Signature:C� � Date:.:,-"�� <br /> Print Name: Aolz&iq e6— r2AhT Signature; i' — Y Date: <br /> Print Name: <br /> Signature: Date: <br /> F'.OEVSVCIPlanning Application Forms\ Page 55 of 7 <br /> Lot Line Adjustment.doc.{Revised 6-4-44)l <br />