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PQl.I i1y <br />! c° APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :. FILE NUMBER: <br /> AUTHO°RIZATIOW SIGNi�i7t1RES <br /> FONLY THE OWNER.OF THiE PROPERTY.OR AN AUTHORIZED�AGENT MAY FILE AN.APPLlCATION:. ., e 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 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 application, or <br /> E); 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 /> Print Name: (e'le'4'C-Q n Signature: <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:�DEVSVManningApplication Fonns4 Page 5 of 7 <br /> Lot tine Adiustment.doc.(Revised 6-4-04) <br />