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APPLICATION LINE ME <br /> a...,:1 — LOT ADJUSTMENT <br /> T <br /> SAS DAOLIIfV.GAUNT.Y.COMMUNITY DEVELOPMENT DEPARTMENT <br /> - - W FIFE NUMBER: <br /> AUTWMIZATIMSMATtIRES <br /> DNLY THE D71ltNER-OF TWE:PRQP.SRT.YDR.ANALITHORMEDAGENT M�Y-.FI1EJ#-NAP.P.LI�ATtoN. <br /> : 1;'tht3 Owrierl;�igerlt"�'reg,'fo ;defend,=iri�eirlhify_;'arnd�"F�dld=?iamtiess�#�e'Cr�rtit�=�rSc��s�g�ts;"t�cers"arid <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> (,.further,.certify.under.penalty of.perju y:that:l_am.(che: k one): <br /> Legal property owner(o,niner includes artner.trustee',.trustor,.or co orate officer.of the ro e <br /> involved in this application, or P P p rty(s). <br /> ❑ Legal agent (attach proof of the owner's consent to the application of thero e <br /> application andfia��`been acrthrnized tQ p P rty's involved in this <br /> file-orrthelr�behalf. and that the,foregoing application,statements <br /> are true and correct. <br /> Print Name: Signature: <br /> to: /7 <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> -Print•Name: Signature: <br /> Date: <br /> Print-Name: "'Slunatare; <br /> 'pais: <br /> I <br /> I <br /> I <br />