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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c. +'lrp 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 <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: 1 I l c- 7—,,,B Il�q� Signature: A4, Date: <br /> Print Name: �i G %.+4rL."'✓ poli Signature: a h L Date: of O <br /> Print Name: lS6PG[(d 14• 4skz Signature: Date: <br /> { <br /> Print Name: R l Ur'1GV"r-I -1. LOI�/9017 Signature: - Date: 'f v <br /> Print Name: Signature: Date: <br /> F-.%0EMMPiannin9 Application Forms\ Page 5 of 7 <br /> Lot Lina Adjuslment.doc.(Revised 6-4 04) <br />