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aPA" �. APPLICATION - LOT LINE ADJUSTMENT <br /> ESAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �7�g'P FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT M:ANN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the Counagents, officers and <br /> employees from any claim, action or proceeding against the County arising froer/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ,`� Legal property owner (owner includes partner, trustee, trustor, or corporate the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the prolved in thisapplication and have been authorized to file on their behalf., and that the forplication statementsare true and correct. <br /> PrintName: 0 Signature: / / _te: AIN <br /> Print Name: 1 -eSignature: / <br /> Print Name: Date:�Z <br /> Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> --- <br /> F 0EVSVC\Planning Application Folmsl Page 5 of 7 <br /> "Line AUJastment.doc.(Revised 0541-08) <br />