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,t _ •'�ggUl� q <br /> ! 'O <br /> APPLICATION LOT LINE ADJUSTMENT ' <br /> r�,: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN'ALITHORIZED 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 claire, action or proceeding against the Owner/Agent's project. <br /> 1, 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 /> ❑ 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: 1 /� r Signature: 00 <br /> ate: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> I <br /> E0EVSVC1Planning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-041 <br /> S <br />