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% { a F 3 <br /> o�aV.`rrAPPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • q., :P . FILE NUMBER: <br /> I <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER.OF THE-PROPERTY OR AN AUTHORIZED`AGENT MAY FILE AN APPLICATION. <br /> I, 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 Yo. wner(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: Signature: Date: /1 ''0 <br /> Print Name W } f4h L Signature: Date: I 3Q <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 4 <br /> 1 <br /> ROEVSVOPlanning Appitatlon Forms\ Page 5 of 7 <br /> W Line AdjustmenLdot.(Revised 6-4-04) <br /> i <br /> y <br />