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APPLICATION -- LOT LINE ADJUSTMENT <br /> QANJ irl£,r'd $1M r'r'ii iii I V rnAAhAi Ihll"T`V rl�ll i r'iailACnF; iiAv'rs;rt:nt'F- i _ <br /> FILE NUMBER: <br /> AUTHORIZATION 'SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> i <br /> j I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> li employees from any claim, action or proceeding against the Owner/Agent's project. <br /> �E f, further, certify under penalty of perjury that 1 am (check one): <br /> i} <br /> I M/I�Legal property owner (owner includes partner, trustee; trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> I ❑ 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 /> f <br /> fj F=ria�t Name: Q a �i'1 Signature: Date: 2 '_rJ <br /> 3 <br /> Print Name: /r 11 2 -5Signature: Date: <br /> I <br /> h Print Name: Signature: --������ Date: <br /> Ii 7 <br /> I Print Name: Signature: Date: li <br /> �! !I <br /> E Print Name: Signature: Date: <br /> r.T-EVSVCOPi;+nninn Application'Porms, Page 5.of 7 <br /> c;Like A4LIstm_nt.doc,iRevised,6-4-,04j <br />