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r <br /> c° APPLICATION - LOT LINE ADJUSTMENT <br /> `ri' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> k� <br /> FILE NUMBER: <br /> ��/FORS <br /> AUTHORIZATIONR'SIGNATURES <br /> ONLY THE OWNER OFTHE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 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 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. J <br /> Print Name: ET 1�7 CDA N }Sig ature: / `t Date: <br /> Print Name: Z)i /`, 7t; Signature: - 'f :� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> F:IDEVSVCiPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6.4.04) <br />