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^y �b <br /> �garo `APPLICATION - LOT LINE ADJUSTMENT <br /> z y <br /> y' A " K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> p FILE NUMBER- <br /> `� ° _ - AL��HORfZA N�► U,R <br /> h <br /> I, the OwnerlAgent agree, to defend, indemnify, and hold harmless the`County and'its agen#s, officers and ' <br /> employees'from any:.claim, action or.proceeding against tFie Owner/Agent's projec#. <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 /> [� Legal'agent (attach proof of the owner's:consent to the application of the property's involved in this <br /> application and.have beenauthorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: rY Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date; <br /> Punt Name: Signature: Date: <br /> FADEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustmeni.doc.(Revised 6-3-03) <br />