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►- <br /> ' APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> f <br /> AUTHORIZATION SIGNATURES <br /> ffONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE.AN APPLICATION. <br /> , 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 OwnerlAgent's project_ <br /> 1,further, certify under malty of perjury that I am(check one): <br /> f <br /> Legal property owner(owner includes partner,trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's 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 /> nt Name: . ._ m. Signature: 1 .iLd" Date: �G <br /> Print Name: Signature: <br /> ©ate: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signe: <br /> Date: <br /> Print Name: Signature: <br /> - Date: <br /> FA0EVSVC1L%nning AppkaWn Fours% Page 5 of 7 <br /> Lot Line Adiuonwtdoa(Revised 6A-W) <br />