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APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> -CW.- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwnerrAgent agree, to defend, Indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim,action or proceeding against the County arising from the Owner/Agent's project. <br /> I,further,certify under penalty of perjury that 1 am(check one): <br /> Legal property owner(owner includes partner,trustee,trustor, or corporate officer)Of the proparty(a) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the propertys 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 /> Pr"Nsma: N j�l nal Dab: �5 /3 <br /> Prkrt Name' SVgnatura: <br /> Signature: Dale: 4 <br /> Print Nem . — <br /> Pnnt Nan ; d�Vo� <br /> ` <br /> Signature: Date: <br /> Print Name: Signature: Date <br /> F.1[rtuSVGWN g M+rc.uan r� Page 5 of 7 <br /> rte,L1.AOPAM—e (Rr-"Mti-0) <br />