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ice' • - <br /> r ' APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> !, 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 /> Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> Molved In this application, or ' <br /> ❑ Legat agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and havebeen authorized to file on their behalf., and that the foregoing application statements <br /> are true and erred. <br /> Print Name: J✓ N c'NC`L` Signature; • Date: // /! �s- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signawre: Date: <br /> i <br /> ) <br /> I <br /> F.DEvsvcLaaw*V AppkaWn Farms% Page 5 of 7 <br /> W Une AdjusuneMdm lReVWW 6-4-01) <br />