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} <br /> Lor LINE ADJUSTMENT <br /> SANOAQUIN COUNTY COMMUNITY DEVELOPMENT'DEPARMEN T <br /> J <br /> AUMORM477ON SiONATURES <br /> 0NLYTi1E QWNl:R.QF THEPROPERTY RTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICAT70N. <br /> i, <br /> 1, the Owner/Agent agree,to defend,lndemnlly,and hold h4mle33 the County and Its agents,oRkers and employees from any claim,action <br /> or proceeding against the OwneNAgant's project 11 <br /> 1,further, certify under penalty ofperjury that t am(check re): <br /> I' <br /> 01.1"-Legal rope 'corp. <br /> g p rty owner(owner Incudes partner,trustee, trustor,or orate oA7cerJ of the property(s)Involved!n this <br /> application,or , <br /> O Legal agent(attach pivof of the per's consent to the application of the property's Involved in this appllcatlon and <br /> have been authorized to llle on th4!r behalf.,and that the foregoing application statements are true and correct. <br /> I , <br /> Ji <br /> i <br /> i' <br /> Print Name: �O,ero i�fS/ /`�i s✓<�f�G ':' Signature: Date: <br /> Print Name: d y: 'D eq-1 r o r A acrr .: Signature: X Date: ele d <br /> yk <br /> Print Name: cTQi ea- Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I; <br /> ,I <br /> I , <br /> i <br /> i <br /> i <br /> i <br /> i <br /> 1:41 PMPA—LAK Fabivery 1,7990 , <br /> -4- <br />