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ik <br /> APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER- <br /> 0 <br /> ZE 1-HE�PC, fi8 AY 1L ANA ' ICA�`M 1N .: <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> H I <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> 11 <br /> El 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 owners consent to the application of the property's involved in this <br /> application and hive been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name D.. Signature: Date: I;Ztlbtc <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> PrintName: Signature: Date: <br /> Print Name: Signature: Date: <br /> fill <br /> II <br /> ii <br /> -FAIDEVS=131anning Application Forms\ Page 5 of 7 <br /> t. Lot Line Adjustment.doc.(Revised 6A-04) <br />