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APPLICATION.- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILENUMBER . <br /> t _ - �, Z -R .( ��� rol�.: W� ���x.•'+X. �(��"F' '•r�SY w'F l� �J d3 -�Y ++Z....�T. - � <br /> -fr1Js'n. - <br /> ' Di�l���#_lj _��Ij~t�t��'��'�R��._ Of�.At��i4UT�l0_ _ Q-�►GE�IT'��Flk-� 'i?t-f�A � <br /> 1, tthe QwnerlAgent agree, to'defend, indemnify;.aria hold harmless the County and its agents, officers,and. - <br /> employees fcorri.ariy da'tm, action or proceeding'aga nst the 0wh6rfAgent7s project <br /> 1,further;:.certifiy.underpenaity,ofperjury thaf l am(d�edc one) <br /> ❑ <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 /> Is application and have'been.authorized to file.on their behatf., and that themforegoing application statements <br /> are true and correct. <br /> I Print Name: ID D n Cin } Signature: Date: <br /> Print Name: ������ , 12}AC ' -t Signature: e�� Date: <br /> e <br /> LPrnirdName: <br /> Signatu - Date: <br /> Signature: Date: <br /> } <br /> ? Signature: t��AQ e" -c L, Loc" Date: to <br /> V, ctn l`�iz a �-c E �,�e �� ' S",R u K Cz, <br /> � e � � y <br /> 5 <br /> r 5 C>-'4izl -I--ed l f4cJ o-s o,,P, # � C" rnA4$czs <br /> �ovr9 �rLG�� Dyc: ea1Qe " � c1vlCit � <br /> F_M)EMCPbrming Application Formsl Page S of 7 <br /> Lot tree Adjus"entdoc_%Revised 6303) <br />