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F <br /> e - • <br /> S ♦ " <br /> LOT LINE ADJUSTMENT <br /> ! COUNTY COMMUNIry DEVELOPMENT Q"P RTMENT <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penalty of per/ury that I am(check one): <br /> Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> O Legal agent(attach proof of the owners consent to the application of the property's Involved In this application and <br /> have been authorized to Ole on their behalf.,and that the foregoing application statements are true and correct, <br /> Print Name: Signature: Date: <br /> Name: / +t-t!n Signature: Date: <br /> Print Nam g <br /> k Print Name: A-0 a <br /> Signature: Dater <br />! Print Name: E Signature: Date: <br /> Ih <br /> Print Name: Signature: Date: <br /> r <br /> 1 <br /> Y <br /> 1 <br /> I <br /> r , <br /> ttbPVIER/IDARK/PLANAPP9/LOTLINGDJAPPFOM Ft"2/1/99 —9— <br /> } <br /> p 1 <br />