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--� APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4.,. `,:;P. FILE NUMBER: <br /> ��FOR� <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 County arising from 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 /> Print Name: LlJivna I ( Signet ur Date: <br /> Print Name: ,L or-nat �7 4 iirr< v Signature: Date: <br /> Print Name: Wet rr a-ter � I Fury Signature: �Q'Y Date: 7 <br /> Print Name: Loi TtL �ur'y Signature: Date: 2 Znlin <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Applicabon Foons\ Page 5 of 7 <br />