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APPLICATION — LOT LINE ADJUSTMENT <br /> z; t <br /> SAN JOAQUIN COIJNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •.cq.-..s_:.;;P. FILE NUMBER: <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 /> 4011 Print Name: ij Awl / Signatur Date: <br /> Print Name: L. ornct �T Q 1ivrd v Signature: Dater <br /> Print Name: 1.1 tt r're 7-L I l or Signature: Date: 0 'Z eD I� <br /> Print Name: [5 Tit UUY a/ Signature: <br /> Li" Zulto <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\Planning Application Fofms\ Page 5 of 7 <br />