Laserfiche WebLink
a°44 ;•.x° APPLICATION - LOT LINE ADJUSTMENT <br /> r t j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �•. FILE NUMBER: <br /> � FORN <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 true and correct. <br /> I <br /> Print Name: 20LA b W—j i ,QL L Signature: Date: /0 —/ <br /> /� v <br /> Print Name: L ��Old 7 f r) )T F�� Signature: Date: �g <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FAIDEVSMIDIanning Applicaton Foons\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />