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i.__ }PLICATION -- LOT L.w. ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> €i <br /> i <br /> 9<<FpR�P FILE NUMBER: <br /> f <br /> :i <br /> j AUTHORIZATION SIGNATURES <br /> !.a ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> .� f <br /> I, the Owner/Agent agree, to de#end, indemnify, and hold harmless the County and its agents, officers and <br /> i the <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I � <br /> ,i 1, further, certify under penalty of perjury that I am (check one): <br /> �! property Legal e <br /> g P rty owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> E involved in this application, or <br /> `r <br /> i' ❑ 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. that the foregoing application statements <br /> ;i are true and correct. <br /> Print Name: 6 I.r 41E: C_OWI- 4-/a � <br /> Signature: Date: <br /> Print Name: <br /> Signature., <br /> Date: <br /> E� Print Name: Signature: <br /> Dale: <br /> Print Name: Signature: <br /> Date: <br /> 'I Print Name: Signature: <br /> -<< Date: <br /> p 5 <br /> i <br /> d <br /> `i <br /> i <br /> .i <br /> i <br /> i <br /> I <br /> i <br /> �j <br /> i <br /> F:IDEVSVOPlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc_(Revised 6-4-04) <br /> r <br />