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it a 4 <br /> °eRU�N� APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ir <br /> � 1FaP FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> j 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 /> E <br /> []x Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 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: MARY H. HICKS <br /> Signature: bate: <br /> Print Name- JAMES M. HAMMONDS <br /> Signature: Date: <br /> i <br /> Print Name: WILLIAM Ea HAMMONDS Signature: Date: <br /> i <br /> fi Print Name: TIMOTHY R. HALL <br /> Signature: Date: <br /> Print Name: JASON H. HALL Signature: Date: —( <br /> i <br /> i <br /> FADEVSMPlanning Application Forms\ Page 5 O€ <br /> Lai Line Adjustment.doc.(Revised 6-4-04) <br /> I <br /> I <br />