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t` <br /> , . ` C) <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> r� 4} SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \`• FILE NUMBER: <br /> i <br /> AUTHORIZATION SIGNATURES' <br /> ONLY THEO _ . <br /> WNER.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 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 /> tf <br /> tt 4 <br /> Print Name: C'A�C�I 'f N��•�r5 Signatures• :` r� i= . - :' " Dale: <br /> T <br /> Print Name: Ic'S7`rr / e,1,-41,1111 Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: T <br /> F:1DEVSVC\Pianning Application Formsl Page 5 of 7 <br /> Lot Line AdjU$tMen1'd0C.(Revised 6-4-04) <br />