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L ..T LINE ADJUSTMENT <br /> s. <br /> SAN JOARUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ..: `:� ZpITION SACJNA�7IRES <br /> �iilE7fiCll71 <br /> y oNLYt r ie.P TK R 1�u ►viuZ �ltaFl►rMAYariERnr APPt�` r+ohr <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,ot►fcers and employees from any claim,action or <br /> proceeding against the OwnedAgenVa project: <br /> 1,further, certify ander penalty of perjury that l am(check one): <br /> Legal property owner(owner Includes partner,trustee,tnrator,or corporate off caq of the property(s)Involved In this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> i <br /> Print Name: ora Lam 9 rr, ��_ Signa ture ^ Date: 12_18_41 <br /> �1 ' Date: 1?�� 01 <br /> Print Name: _A rn,-, L a r a Signature <br /> Print Name: Signature: Date: <br /> Print Name: Signature: _ Date: <br /> Print Name: Signature: Date: <br /> r' <br /> L <br /> 10ASAMPkLAW f*WmY 1.1M - <br /> i <br />