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,.. .r° kPPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .._ a... <br /> OR.''.P • FILE NUMBER: <br /> <iF � <br /> AUTHORIZATION SIGNATURES <br /> FONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT=MAY =APPLICATION. <br /> 111, the Owner/Agent agree, to defend, indemnify, and hold harmless the Countyers and <br /> employees from any claim, action or proceeding against the Owner/Agent's proje <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> IkLegal property owner(owner includes partner, trustee, trustor, or corporate ofsinvolvedin this application, or ( )❑ Legal agent (attach proof of the owner's consent to the application of the propertys 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: �T� ST.�Ts�s-- Signature: - <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> LLPrintName: <br /> Signature: <br /> Date: <br /> Signature: <br /> Date: <br /> F:\DFVSVOPIanningApplication Forms\ page 5 of 7- <br /> Lot"Line Adjustment.dod.(Revised 63-03) <br />