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kl <br /> Y. <br /> ' TM APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> ` FILE NUMBER. <br /> fr 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 /> ❑x 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 lication statements <br /> are true and correct. <br /> i 1 <br /> Print Name: MARY H. HICKS Signature: D. <br /> Print Name: JAMES M. HAMMONDS Signature: ate: /., G <br /> Print Name: WILLIAM E. HAMMONDS Signatur : Date: <br /> Print Name: TIMOTHY R. HALL Signature; <br /> Date: <br /> Print Name: JASON H. HALL Signature: Date: <br /> ,I <br /> E <br /> `k <br /> I _ <br /> tl <br /> E <br /> E <br /> d <br /> I <br /> I <br /> li <br /> P FADFVSVc%PlanninUApplication Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br /> i <br />