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. G <br /> 'EI t;- <br /> II <br /> APPLICATION ® LOT LINE ADJUSTMENT <br /> y, <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> /r <br /> FILE NUMBER: <br /> I <br /> AUTHORIZATION SIGNATURES <br /> i <br /> 'I <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLllcAnON. <br /> i <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 Owner/Agent's project. <br /> r <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner(owner includes partner, trustee, trustorr, or corporate officer)of the property(s) , <br /> involved in this application, or <br /> i <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. I <br /> i <br /> i Print Name: Y A& P C IL-7—t—N d esig a ure: <br /> Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: , <br /> 1 <br /> j Print Name: Signature: Date: <br /> j Print Name: Signature: Date: I <br /> i� <br /> i <br /> ;I <br /> i <br /> i } <br /> I I � <br /> i <br /> i <br /> ' I <br /> I � <br /> i <br /> k ; i <br /> I <br /> I <br /> FADEVSVOPhrining Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br /> I I <br /> i <br /> I <br /> i1 <br />