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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �., ..:..:..•. P FILE NUMBER: <br /> I ' AUTHORIZATIQN SIGNATU.RES <br /> ONLY THE OWNER OF THE PROPERTY.OR AN AUTHORIZEID AGi NT MAY FILE AN'ARPL1CATfON. <br /> i <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action or proceeding against the Owner/Agent's project. <br /> I <br /> I, further, certify under penalty of perjury that I am (check one: <br /> X Legal property owner:(owner includes partner, trustee, trustor or corporate officer) of the property(s) involved in <br /> this application, or I <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print I <br /> Name: Mark Lewallen Signature: "�Y\ s " Date: <br /> Print <br /> Name: Tom Conlin Signature: i Date: o -�� �0 <br /> Print <br /> Name: Susan Conlin Signature: Date: <br /> I <br /> Print i <br /> Name: Signature: Date: <br /> Print <br /> Name: Signature: Date: <br /> 1 <br /> I' <br /> i <br /> F:DFVSVC/Planning Application Forms/ <br /> Lot Line Adjustment doc. (Revised 06-04-04) Page 3 of 3 Job No 2005-26 <br /> 1 <br />