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l _ <br /> 1 <br /> 1-WPLICATION <br /> l <br /> 2 - LOT <br /> r114F <br /> ADJUSTMENTSAN JOAQUIN COUNTY COMMUNITY VELOPMENT DEPARTMENT <br /> l FILE NUMBER: <br /> - <br /> ��� Ps <br /> 7-1-1 <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County <br /> } employees from any claim, action or proceeding against the Owner/Agent's Project.nd its agents, officers and <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 r <br /> involved in this application, or ) p operty(s) <br /> ❑ Legal agent (attach proof of the owner's consent to the application of theproperty's involved i <br /> n t <br /> application and have been authorized to file on their behalf., and that the'foregoing application his <br /> are true and correct. <br /> I <br /> Print Name: Laren Scott viss <br /> Signature: <br /> Print Name: Karen L n Viss �� Date: <br /> Signature: J <br /> Print Name: Date: <br /> Signature: <br /> [Print <br /> t Name: Date: 3 <br /> Signature: ; <br /> Name: Date: k <br /> Signature: <br /> Date: <br /> i <br /> I <br /> I� <br /> 5 <br /> I <br /> i <br /> FaDEVSVC\Planning Application Forms\ <br /> i <br /> Lot Line Adjustment.doc.(Revised 6.4-04) Page 3 of 3 <br /> 2005-83 LL! <br /> ' i <br />