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PPL <br /> ICATION -- LOT CWE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;. <br /> FILE NUMBER: <br /> "Of 6110 <br /> P1, <br /> 'a ay , x 9_,f 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 /> W 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 /> Print Name: K� Signature: Date: <br /> Print Name: 14 , Signature: ZJ [late: <br /> E.'i�2�'C-J� o �A► Signature: Date: <br /> Print Name: <br /> e Signature: Date:.1-2- 7 <br /> Print Name: g <br /> Print Name: Signature: Date: <br /> F:1DEvsvc\Plann1rng Application Formsl Page 5 of 7 <br /> Lot Line Adjustment doc.(Revised 84.04) <br /> i <br /> I <br />