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°>4�. �. APPLICATION - LOT LINE ADJUSTMENT <br /> ": SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .°' .. FILE NUMBER: <br /> i�d"aN <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE 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 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 foregoing application statements <br /> are true and correct. <br /> Print Name: ( Slgnature: Date: <br /> Pdnt Name: /Uri 116 Signatu Date: <br /> Print Name:"OI OAkf Lt . Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSM%nn1ny ApplkeUon Forms\ Page 5 of 7 <br /> W tine A.djustrn .dm(Re As d 6-4-04) <br />