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_OT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .s <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAYFILE AN APPLICAMN, <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> 0 Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of the property(s)involved In this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and have <br /> been authorized to We on their behalf.,and that the foregoing application statements are true and correct. <br /> I <br /> Print Name: t�,N S Signature: Date: <br /> Print Name: i*v /eifi< Signature: i r �7�Gyi_;i Date: --6'-- <br /> Print,Name: i �� Lt YI el Signature: _ Date: G( <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 10:07 MAPA LABS F b-,y 1,1888 <br />