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"a APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> P ( FILE NUMBER: <br /> btoii� j <br /> O�+1LX TEl1�VNR,OF THEPRO .ERT�fxORrANi UH.ORIED,AGEN �VI }( FILN�APPLCATtON_ <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 /> 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 /> involved in this application, or <br /> 0 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 Ti correct. <br /> Print Name: 1 M a*S j Kes5+T. _ Signature: �J Date: 1P 10 O S <br /> Print Name: D ay C� ��e r Signature: Xjeje- ��� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1DEVSVOPlanning Application Formsti Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-3-03) <br />