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LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUT40RlL4TION SIGNATURES i <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers,and employees from <br /> any claim,action,or proceeding against the Owner/Agent's project. <br /> 1,further,certify under penalty of perjury that 1 am(check one): <br /> dLegal property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s)Involved in this <br /> application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and ! <br /> have been authorized to file on their behalo,and that the foregoing application statements ars true and correct <br /> I <br /> ' <br /> Print Nip �77 '—" n ure: Date: <br /> Print Name:' Signatu _ R Date: C1 <br /> Print Name: Signatu <br /> Date: -7•-2 4--3 <br /> Print NameEn&l +,-! r)O O69 X56 n Signature: Date: — O <br /> Print Name: Signature: Date: <br /> i <br /> P ASTOC K TO M 12285400tidocs\App Lot Li neAdjust men t.doc <br />