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T : <br /> o <br /> IIJ <br /> 5A <br /> iLOT LINE ADJUSTMENT <br /> OA <br /> U!N COUNTY COMMUNITY DEVELOPMENT DEPARTMEN <br /> A ' 171Z,4' ION: lGNAFLIR :, <br /> u <br /> y F p N I bA <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any <br /> proceedin <br /> claim,action or <br /> g against the Owner/Agent's project. <br /> 1,further, cer"y under penalty of perjury that l am(check one): <br /> O Legal property owner(owner includes partner,trustee,grantor, or corporate officer)of the property(q)involved in <br /> this application,or <br /> O Legal agent(attach-proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> [LPfintName; <br /> Signature: Date: <br /> Signature: Date: <br /> �./ <br /> " M Signature: <br /> GNr9 �NCa/� av'2••✓G, Date:$-/L-to �- <br /> Signature: - Date: <br /> Signature: <br /> Date: <br /> I <br /> r <br /> . F <br /> r <br /> r <br /> .FS DEV9ER/IDARN/PLANAPP91LOTLINEADJAPPM M REV 2/1/99 <br /> -4- <br /> 4 <br /> I4I� <br />