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ry <br /> - �° APPLICATION - LOT LINE ADJUSTMENT <br /> ENT <br /> S< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N" FILE NUMBER: <br /> 3 <br /> 4. <br /> 1 �jf, ` A s }., R j, i•, sx a ^Ys--4ARRVOill <br /> .I i i, 5'k s34.,,.�.•.,` �'p } �� �,5 ic5ef '�fi-,t Z .r 'Ft' ,r1ka r e{ts, n r1i i.1t �i''1,:: � ,;�> <br /> ' ONRY THE OW,IR;OF Tl} rPQ!? ill='QR AN�KA. <br /> . �L�.GHQ,RI��D,��•1.C.�E�IT�M.��f���ILE„AN�APPLI�ATION ,:; <br /> I, the Owner/Agent agree, to defend, ind'emn.ify, and lold harmless the'County and`its agents, .officers and <br /> employees from any claim, action,or proceedirig against the Owner/Agen#'s project. <br /> I, further, certify under penalty of perjury that l am (check one): i <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. <br /> Print Name: u> r: Signature: Date:. l <br /> Print Name: tr% Signature: Date: / <br /> Print Name: Signature: pate: <br /> Print Name: EE <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> d <br /> } <br /> it <br /> I <br /> i <br /> FADEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot line Adjustment,doc.(Revised 63-03) �. <br /> i <br /> II <br /> r.. <br />