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L 0 T LINE ADJUSTMENT <br /> 5AN JOAQU►N COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> h AfITfIORIL4TION S1GNA TURES <br /> ONL Y THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAYFILE AN APPLICATION. <br /> 1, the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from anyJMO <br /> or proceeding against the owner/Agents project <br /> 1, further, certify under penalty of perjury that I am(check one): <br /> O Legal property owner(owner Includes partner, <br /> application,or trustee,trustor,or corporate officer)of the property(s)involved in this <br /> d Legal agent(attach proof of the owner's consent to the application of the property's Involved in this application and <br /> have been authorized to rile on their behalf. and that the foregoing application statements are true and correct <br /> 9 pp <br /> Print Name: / <br /> Signature: <br /> � Print-Name. 't� � 1 ate: <br /> Signature: Date, <br /> Print Name. CJ2 Iq /1 t�c> c T3 Signature: <br /> Data. " Z �� <br /> Print Name: i <br /> QIA=C# Signature: Date: <br /> Print Name: �] Sfgnature: <br /> ate: <br /> k; <br /> I: <br /> F <br />••..tip»-�-;.+•-e.�..a ... ._.._.. . <br /> ¢ A <br /> i <br /> 1:41 PMPkLA99 Fetwuery 1,19991 - <br /> -4- , <br /> i <br /> i <br />