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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> 44 how <br /> 1, 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 County arising from the Owner/Agent's project. <br /> 1,further, certify under penalty of pedury that I am (check one): <br /> I I <br /> Legal property owner(owner includes partner, trustee,trustor, or corporate officer) of the property(s) <br /> Legal <br /> In this application, or <br /> El Legal agent(attach proof of the owners 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: Signature: Date: ?I <br /> Print Name: Signature: Date" <br /> Print Name; i Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RUEVSMPlanning ApplicaUan Farrrsl Page 5 of 7 <br /> Lut WnG Adjustmuli(Rov;md 05-11-09) <br />