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aN APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> (tk6ti -- <br /> AUTHORIZATION SIGNATURES <br /> rthe <br /> HE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> er/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> certify under penalty of perjury that I am (check one): <br /> QQ 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 /> Print Name: Timothy O. McKinsey Signature: '/ TDate: <br /> Print Name: Signature: Date:_ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date:________ <br /> Print Name: Signature: Date: <br /> FADEVsvclvianningAppiioalionFormst Page 5 of 7 <br /> Lot Line Adiustn entdoc.(Revised 0b11-09) <br />