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APPLICATION - LOT LINE ADJUSTMENT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER; <br /> ONLY THE gW►1ER p�THS PR4P..8RT�l pR/1N{f�f lT..p fit}J1 ►4 }�IAY.FIkE mitpEl4Ab <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 <br /> /and <br /> 1 correct. Q <br /> Primt NagiQ. 1 '� 1 F's r i Ll S_� Signature: a Date: Z v <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I Print Name: Signature: Date: <br /> Print Neme: Signature: Date: <br /> G:\DEv5vQPLanning App6ca6on Forms\ Page 5 of 7 <br /> La Line Aljuslmentloc.(Revisal G-U3) <br /> PO 39tia '17AT'7C 71WnW TTo>nccc n> >n n -nn ,t. <br />