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APLICATION - LOT Llh .F- ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> R�lroR� <br /> AUTHORIZATION-SLGNATU.RES. <br /> -ONLY--THE OWNER OF THEPROPERTY OR AN AUTHORIZED AGENT MAY.FI�L_EyANAPPLICATION: <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: DbW Ict p Signature: Date: ;p <br /> Print Name: L e 1"` O Signature: p Date:�" ''0 <br /> Print Name: Signature: Date: <br /> Print Name: _,Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> F:\DEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />