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—E' fi°c APPLICATION -- LOT LINE-ADJUSTMENT <br /> ` ?{ SAN,fOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> " hX ;�:/#,UTHORIZATtON SIGNATURES a - . <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, <br /> to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the OwrterlAgent's Project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner towner includes partner,trustee,'rustor, or corporate officer)of the property(s) <br /> involved In this application,'or <br /> s involved in this <br /> Legal agent(attach proof of the owners consent to theapp application of the property' <br /> uthorized to file on their behalf., and that the foregoing application statements <br /> application and have been a <br /> are <br /> true and correct. <br /> ata <br /> !'s Signature: , <br /> Print[Name: Dat <br /> ,a r• Signature: <br /> Print Name: Date: <br /> Print Name: �T�y� F��� ' Signature: <br /> Date: l� d <br /> �Y. Signature: <br /> Print Name: �'' Date: <br /> Print Name: <br /> Signature: <br /> i <br /> I <br /> I <br /> FiDEVSVCIPSarnlnp App! <br /> Format Page 5 of 7 <br /> Lot Lana AAuWmaLdoo.(RWjwW&4-04) <br />