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M Cf f 4 <br /> LW''LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUIIIORIZATION SIGNATURES JI <br /> ONLY THE OWNER OF THE PROPERTY OR AN AU1110RIZED AGENT MAY FILE ANAPPLICATION <br /> i <br /> the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents, officers and employees from any claire,action <br /> or proceeding against the Owner/Agent's project. <br /> t, further certify ander penalty of petitory that I am(check one.): <br /> )b� Legal property owner(owner includes partner, trustee, Trustor, orcorporate 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 <br /> have been authorized to file on their behalf, and that the foregoing application statements are true and correct. <br /> Print Name:_ il�+__V .0 Signature: _ Date: 5 b <br /> Print Name: QC 1. _V Signature: r` 1 � �i Date:!111 <br /> Print Name:_ _ _ 5igrratul : Date: <br /> Print Name: Signature: Date: <br />