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Ar PLICATION - LOT L1NE � DJUSTM <br /> I ENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I FILE NUMBER: <br /> O <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> G <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the Count and i <br /> employees from any claim, action or proceeding against the Owner/Agent's project, Y is agents, officers and <br /> I <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> ® Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of theerty(s) <br /> ro <br /> involved in this application, or <br /> p p � <br /> I <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 a <br /> are true and correct. g licati pp on statement <br /> a <br /> Print Name: <br /> Signature: <br /> Print Name; <br /> Date: I <br /> Signa re: <br /> Print Name: —— Date: <br /> Signature: <br /> Print Name: <br /> Date: <br /> Signature: <br /> Print Name: <br /> Date: <br /> Signature: <br /> Date: <br /> I <br /> r <br /> F:\\DFVSVC11PIanning Application Formsl\ Page 5 of 7 <br /> Lot Line Adjust mentdoc.(Revised 6-4-04) <br />