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� e <br /> z; <br /> ' APPLICATION - LOT LINE ADJUSTMENT <br /> h " < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the OwnerlAgent 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 /> 1,further,certify under penally of perjury that 1 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 rty's in Ived in this <br /> application and have been authorized to file on their beh f.,and that the <br /> r ing app cation statements <br /> are true and correct./� <br /> Print Name: R Signature: Date: <br /> Print Name: Tp�NA V,% Signature✓5Date: —�- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Y:10EV2,VC\Pianning AppFtalion Forms\ Page 5 of 7 <br /> 101 Line Ad)usimeN do .(Revised 0$-0149) <br />