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°PA�?`k APPLICATION _ LOT LINE ADJUSTMENT <br /> T. - <br /> � ' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> e' FILE NUMBER: <br /> fi <br /> x ` av <br /> ' --2 �AUTHORI�ATION'SIGNATL RES <br /> ,O '" <br /> =. ONLYTFiE OWNER°OF TNiE PROP�RTY,OR AN AUTF�DRIZ�DAGNT MAY FILE-AN APPLI; ATIDN , • 4 <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 application statements <br /> are true and correct. <br /> Print Name: MARY H. HICKS Signature: Date: <br /> Print Name: JAMES M. HAMMONDS Signature: Date: <br /> Print Name: WILLIAM E. HAMMONDS Signature: Date: <br /> Print Name. TIMOTHY R. HALL Signature: Date: <br /> Print Name: JASON H. HALL Signature: Date: <br /> f <br /> F1)EVSVCTlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />