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��Q_U <br /> :;�. APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> cP/. <br /> FILE NUMBER_ <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the 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 Owner/Agent's project. <br /> I, further, certify under penally of perjury that I am (check one): <br /> �] Legal property owner (o finer 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. I <br /> _r�"f C-n <br /> -0F^L <br /> Print Name: Signature: Date: <br /> Print Name: < ��7 /it r: 1[ti c Signature: Date: <br /> L � ' � f <br /> Print Name: �� ��S' Signature: f"Date D <br /> Print Name. ' Signature: Date: <br /> Print Name: Signature: Date <br /> 1 _ <br /> i <br /> F IDEVSJr;,P P.nnmg rnpi cafpon Foy,s� Page 5 of 7 <br /> Lot L-ne AdjslrnErt.[fiiRevsed ri-<.v 1 <br /> i <br />