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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO.: <br /> ............... <br /> lkt <br /> S00mu <br /> T,u <br /> . ..... ....... . 1............. <br /> .......... ... . .. .....t <br /> 1-1-........I <br /> 1,the Owner/Agent agree,to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the County arising from the OwneriAgencs project. <br /> 1,further,certify under penalty of perjury that I am(check one): <br /> 1113" Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> F3 Legal agent(attach proof of the owner's consent to the application)of the owner of the property(s) <br /> involved in this application and have been authorized to file on their behalf,and that the foregoing <br /> application statements are true and correct to the best of my knowledge and belief. <br /> -r,5�k,c- Signature: <br /> Print Name: IZZ,., 7 Date: 2` <br /> Print Name: 5 Signature: Date: <br /> Print Name: b 6 1-1-d Signature: Date: <br /> Print Name: Signature: Date: I <br /> Print Name: 61 Date: 2-1110 <br /> OLW Signature: 9L <br /> Iii <br />