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as"-= APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �(:IFppY�P • FILE NUMBER: _ <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 and <br /> employees from any claim, action or proceeding against the County arising from 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 /> ❑ 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 truce and correct. <br /> Print Name: Lkt1ailjSignature- Date:,S <br /> Print Name: �G YheS UQ L �{ Signature: Ot Dates 31' /Z— <br /> Print <br /> Name: - 7L714 !]J' q Signature: Date: ., i /2- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVc\Planning Application Fonnsl Page 5 of 7 <br /> Lot Line Adjustment.dm (Revised 05-11-09) <br />