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A��-PLICATION -- LOT Li�:.�E ADJUSTMENT <br /> USTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION^SIGNATURES ; <br /> ONLYTHE?OWNER OF THE PROPERTY OR AN AUTHORIZED',AGENT MAY FILE A <br /> N 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: �O Signature: .� Date:�� o` <br /> Print Name: L !^ p Signature: Date: " —0 <br /> Print Name: Signature: Date: I <br /> Print.Name: Signature: Date: <br /> Print Name: Signature:, Date: <br /> i <br /> FIDEVSVC\PIanningApplication Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc,(Revised 6-4-04) <br />