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APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> '.t,e Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers an <br /> oloyees from any claim action or proceeding against the Owner/Agent's project. d <br /> ---Jrfner, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this applicatio.ri, 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 /> 2,rtrue and cc,rrect. <br /> Name: Kurt A. Kautz Signature: <br /> 1(k 4 Date <br /> Signature: <br /> Signature: <br /> Signature: <br /> Date <br /> S€gnature: Date---- <br /> 7.-Vcz\'K;�Plarmrprlg Application 1 cS- <br /> -..-.. <br /> SPage 3 of:3 Job No 2011-161 LM Line Ad!ustrnc— <br /> .............. .......................... <br /> .................... <br /> ...................- ....... . ....... <br />