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f A <br />� Rl <br /> T . .. APPLICATION ® LOT' LINE ADJiJSTII�EIV`T <br /> a <br /> !a <br /> K SAN JOAQU COUNTY;COMMUNITy DEVELOPMEfVT�EPi412TMENT. <br /> FILE NUMBER: <br /> I <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the Count and its a <br /> employees from any claim, action or proceeding against the OwnerlAgent's project, gen <br /> ts, officers and <br /> k <br /> Ij 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 t <br /> involved in this application, or <br /> he property(s)p perty(s) <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's Involve <br /> application and have been authorized to file on their behalf., and that the foreoin 'applicat odn'sstatements <br /> are true and correct. <br /> r <br /> Print Name: <br /> Signature: ' <br /> Print Name: Date: <br /> E Signature: Date: <br /> Print Name; Signature: <br /> Print Name: Date: <br /> Signature: Date; <br /> Print Name: Signature: <br /> EI Date: <br /> I� <br /> t <br /> E, <br /> `I <br /> fF k <br /> i <br /> I <br /> € k <br /> 1 <br /> I' <br /> 1 <br /> h <br /> F•10F1/9V!'IP1anninn Annliralinn Forms% <br /> r� Paee 5 of 7 <br />