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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> N C/FORt� <br /> 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 an <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 /> (� Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s) <br /> Involved in this application,or <br /> F-] 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 statement <br /> are true and correct. <br /> Print Name: C' Nt 1G; j Com,, Q�et_i! ,)-Signature: �'� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FMI)EMCI\Planning Application Forms\\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />