Laserfiche WebLink
r�T LINE ADJUSTMENT <br /> SM JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> L-0 RM V I AW. <br /> i,the ownedAgent agree,to delimd,Indemnify,and hold harmless the County and its agents,officem and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify undar penalty of perjury that I am(chock one): <br /> • Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved in this <br /> appocago" or <br /> • Legal agent(affach proof of the owners consent to the application of the property's Involved In this application and have <br /> been authorized to We on Moir b~.,and that the foregoing application statements are true and correct <br /> Print Name Signature: <br /> 10 <br /> Print Name: Signature: Dateeg <br /> Print Name: Signatu <br /> U <br /> Print Name. Signature: Date: <br /> Print Name, Signature: Date. <br /> -4- <br />