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APPLICATION - LOT LINE ADJUSTMENT <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .. . ._. .�P. FILE NUMBER: <br /> Iii=b'r+� <br /> A <br /> v ..... UTHORLZATIUN SI:G,NATURES_----- <br /> ____ _.......___—._....,_...__.- <br /> ......c....,ai' 'rr, n <br /> i". -CA <br /> �I_1?.�li1C C'jI, •JT�__• _ <br /> E: ._ROPE TY O UHORIZED% GE7�MAlIrl AN/�►PPLICATION _ <br /> ONN,�XTHE_OWN_ R_OF TH -,Q .. R _. RA A - _ .....-- T.- <br /> E. <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: Ivl Kf ✓�— Signature: -/17Z (/4 �.. �� 7� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVOT[anning Application Formsl Page 5 of 7 <br /> Lot Llne Adjustment.doc.(Revised 64-04) <br />