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?APPLICATION <br /> LOT L <br /> SAN INE ADJUSTMENT <br /> JOAQUIN COUNTY COMMUNITY DEVEL <br /> ;�—Z5 <br /> OPMENT DEPARTMENT <br /> FILE NUMBER, <br /> AUTHORIZATION <br /> ONLY THE OWNER OF THE PROPERTY OR ANAUTHORIZES AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, <br /> employees from any claim, action or Proceeding against the Owner/Agent's project. Officers and <br /> y <br /> 11 further, certify under Penalty of p <br /> ER Legal propertyowner <br /> .1' erII <br /> jury that I am (check one): <br /> Owner (owner includes partner, trustee, trustor <br /> involved in this application, or , Or corporate Officer) of the Property(s) <br /> El 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. <br /> are true and correct. <br /> and that the foregoing application statements <br /> Print Name: Ra(Mond Vieira <br /> Print Name: Richard, .Vieir',� Signature:, <br /> Print Name: Signature: 10' Date: <br /> Date: <br /> Print Name: Signature: <br /> Print Name: Signature: Date:------- <br /> 7------- <br /> Signature: Date: <br /> Date: <br /> F:OEVSVCVPiarining Application Forms% <br /> Lot Line Adiustment.doc.(Revised 6-4-04) Page 3 of 3 <br /> Job No 2004-173 LLA,doc <br />