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LOT LINE ADJUSTMENT <br /> SAN JOA U1N COUNTY COMM QPMENT DEPARTMEENT <br /> AUTNORl7ATlDN SlGNA'TURES <br /> ONLY THE OWNER OF THE PROAERTY OR AN AUTNORlZED AGENT MAY FILE AN APPLICATION, <br /> 1,'the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> E proceeding against the Owner/Agent's project. <br /> 1, further, certify under penalty of perjurythat!am(check one): <br /> O Legal property owner(owner includes partner, trustee,grantor, or corporate officer)of the property(s)involved in <br /> this i pplicatlon,or <br /> E <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> i have been authorized to rile on their behalf.,and that the fore application statements are true and correct. <br /> foregoing pA <br /> Print Name: —L Signature: <br /> Date: <br /> Print Name: <br /> Eh Signature: - Date: Z1Z 7 D <br /> Prin't.Name: <br /> ! , Signature: Date: <br /> jf , <br /> Print Name: Y; Signature: Rafe; <br /> E Print Name: <br /> Signature: Date: <br /> i <br /> E! ' <br /> , <br /> li <br /> i <br /> E <br /> A f <br /> P <br /> II �� <br /> j E <br /> 4. <br /> E � <br /> h <br /> !E <br /> ;f <br /> .a <br /> ! 4 F:pEySER/IOARK/PLANAPPS/WTLINEADJykPPFGRM REV 2/1/99 <br /> I <br /> I{ iii <br />