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APPLICATION - LOT LINE ADJUSTMENT <br /> rIE < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c •. ;� FILE NUMBER: <br /> ai%Frigt'` <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY-THE OWNER OF THE PROPERTY OR AN AUTHORIZED,AGENT;MAY,FILE.AN APPLICATION. <br /> I, the Owner/Agent agree, toldefend, 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 /> property .Wobr-(6w ner.includes partner,trustee,°trustor,:or corporate:officer) of the property(s) <br /> involved in this application, or <br /> E <br /> ❑ Legal agent(attach proof of the owner's consent to the appli n of the property's involved in this <br /> application and have been authorized to file on their behal d that the foregoing application statements <br /> are true and correct. <br /> t <br /> Print Name: 67ZAA alp �c?`�7rJ�i�� Signature: Date: <br /> + <br /> Print Name: G LZAZIA L "7�MA" �!� Signature: ? �� y-`' L -mate: <br /> Print Name: ! Signature: f Date: <br /> Print Name: Signature: Date: <br /> Print Marne: Signature: Date: <br /> FADEVSMPlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />