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N ' <br /> I+ <br /> -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 6•"CX" <br /> ir�o• <br /> FILE NUMBER: <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 County arising from the Owner/Agents project. <br /> 1,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: 1&RIU6. o JfV4 Signature: Date: 5 <br /> Print Name: r Signature= Date: <br /> Print Name: �� a� Br�p1,v Signature: Date: <br /> Print Name: Solna; o� Signature: Date:_ 57— <br /> Print Name: Signature: or Date: <br /> I <br /> F-oEvsVoplanning Application Formsl Page 5 of 7 <br /> Loi Line Adjustment-doe.(Revised 05-11-09) <br />