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� f a <br /> - '..� APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4 ;P FILE NUMBER: <br /> E3 <br /> - AUTNORIZATI'OrN SfiGNATURES ^ " <br /> ONLY,THE.,OWNS_ R 4F THE PROPERTY,OR=AN,AUTHORIZED AGENT MAY F1kE AN <br /> APPLiCAT <br /> I.ON. <br /> the Owner/Agent agree, to defend, indemnify, and hold harmlesstheCounty and its agents, officers and <br /> employees from-any claim, action or proceeding against the Owner/Agent's peoject. <br /> Ii <br /> f, further, certify under penalty of perjury that I am (check one): <br /> !i <br /> li Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> �j <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 /> �i <br /> Print Name: V 1-FO 13ory.,7Y'C7 Signature: " Date: 7/l_YZ42 �s <br /> f3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> !1 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> E <br /> II <br /> ,i <br /> i� <br /> !1 <br /> € <br /> !1 <br /> r <br /> E' <br /> �! w <br /> Ej <br /> F:%DEVSVCIPIanning Application Forms% Page 5 of 7 <br /> i Lot Line Adjustment,doc.(Revised 63-03) <br />