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Alk Adft <br /> PPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> 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 /> XLegal property owner (owner includes partner, trustee, trustor or corporate officer) of the property(s) involved in <br /> this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print <br /> Name: Dalt Roza Signature: Date: Z "-13-CA <br /> Print L <br /> Name: Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> F:DEVSVC/Planning Application Forms/ <br /> Lot Line Adjustment doc. (Revised 06-04-04) Page 3 of 3 Job No 2003-86 <br />