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APPLICATION LOT LOT LINE. ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION:SIG AT <br /> `NA ORES <br /> ?Cry .v,H•." tar>-• i;,,.Fx'�i:;?,��Arsa?�?'y�c 5z; �`,'+",; i;. :?; t ..`, 'f,7F �...'�,:: ',��.•-�.� •i..:i:.�,-, `�'- :.t .,t:- .. .. <br /> ONLY THE OWNER O1F<THE>PROPERTY OR'ANAUTHORIZED:AGENT MAY FILE AI PPUCATION. <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 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: ���A Al- Xe-^f6 � Signature: "0 Date: <br /> Print Name: Xe Signatu Date: <br /> Print Name: Je--Z .Ar A.11e ar Ar.:� Signature: &LAI <br /> r, Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> i <br /> FADEMCPanning Appfica lon Formal Page 5 of 7 <br /> La Lina A4uat„antdoe.(Rued 04-04) o•� SQ h <br /> C°O <br /> t671 <br />