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n, <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> X SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> U <br /> THORIZAT,"" SIGNATURES'' <br /> u <br /> 'ONLY.JH ,,� <br /> CO.W <br /> NER0117 THE:#,900`115,'W <br /> 1, 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 /> 1, 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: *3 APN) Signature: <br /> Print Name: Signature: - Date: <br /> Print Name: Signature: - Date: <br /> Print Name: Signature: - Date: <br /> Print Name: Signature: Date: <br /> FA01EMCIP10 nning Appfication Forms% Page 5 of 7 <br /> Lot Line Adjustment.duc.(Revised&4-04) <br />