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°Aa�Ih. APPLICATION - LOT LINE ADJUSTMENT <br /> ?< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> t�RORT� <br /> AUTHORIZATION SIGNATURES <br /> Alitl <br /> ONLYTHE 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 foreg�Ing application statements <br /> are true and correct. <br /> �( n <br /> Print Name: GSck �:, CSignature: \ (- Date: <br /> Print Name: Is - A Signature: Date: -2 Y— <br /> Print Name: Signature: Date: q&-5 ky <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F,TEVSVOPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustmeni.doc.(Revised 05-11-09) <br />