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pp4p N ° APPLICATION - LOT LINE ADJUSTMENT <br /> a: Z� <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ' - i <br /> �•,. Y FILE NUMBER: <br /> 1 6:iN <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, 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 /> I, further, certify under penalty of perjury that I am (check one): <br /> f 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 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 /> t� n@ r <br /> Print Name: \'ox.tfi� 1t_C'forz� signature: Date: I 13 <br /> Print Name: SU2c,40A CoTt'04 &WAO) Signature: � Date: 1113 bib <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> F:IDEVS=PlanningApplication Fonnsl Page 5 of 7 <br /> Lot Line Adjusvnent.doc.(Revised 6-4-04) <br />