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'°P c APPLICATION — LOT LINE ADJUSTMENT <br /> Z <br /> C < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �/PORN <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 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: N)()JN 1 T r7 N u 1 T;PV Signature: U l A , Date: <br /> Print Name: Ll S/4 T+fA G V1 EN Signature: � ��� ; � ✓ Date: <br /> Print Name: Signature: Date: 1 <br /> Print Name: - I+' U Signature: i 4�� Date: -`2 <br /> -1J r �-� <br /> Print Name: of�Y S . FP CAUL-) Signature: Date: 94-12 <br /> F:\DEVSVC\Planning Application Fonns\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-0-04) <br />