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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ii <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 /> I employees from any claim, action or proceeding against the Owner/Agent's project. <br /> i <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 /> i 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 the behalf„ qnd th9lthe foregoing application statements <br /> are we and correct. <br /> Print Name: 5' '? 1 t,p Signature: Date: U <br /> Print Name: Signature: Date: <br /> r Print Name <br /> •• Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVWlanning Appkation iormsl Page 5 of 7 <br /> Lix une/wNsun&cdae(Revised 64-04) <br />