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.y I <br /> I <br /> �� •: APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i <br /> ....... FILE NUMBER- <br /> i <br /> i <br /> AUTHO ►TION $IGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORCMD AGENT MAY'FILE AAI-APPLICATION: <br /> _ i <br /> 1, the OwnedA,gent 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 Owne(/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: Signature: Date: <br /> Print Name: �'Q!' .! SC �°l7 9 Signature: . r, .� _ � Date: !� <br /> I <br /> Print Name: Signature: <br /> Date: <br /> i <br /> Print Name: Signature: Dai 8: <br /> Print Name: Signature: Date: <br /> I <br /> I <br /> i <br /> I <br /> I <br /> I <br /> I <br /> I <br /> I ' <br /> I . <br /> I <br /> I <br /> I <br /> I <br /> F_10EVSVC1P1anning Application Formsl Page 5 of 7 j <br /> Lot Lina Adjustment.doc.(Revised 05-11-09) <br /> i <br /> i <br /> I <br />