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_ � I <br /> f ' _ T LINE ADJUSTMENT <br /> w <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> RU1`NORlZA?7DN 31GNATUReS <br /> ONLYTli1 04VIYER.GFTNEPI.UPERTYORAN'/1U7NORl2EOAGFNI MAY FILE.AN:,AiP.PiYC0.TlON <br /> !,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from agy claim,actign or <br /> proceeding agahrst the Owner/Agent's project. SCA <br /> 1,further, certify under penalty of perjury that i am(check one): NNED <br /> i <br /> V Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> application,or <br /> O Legal agent(attach proof of the owners consent to the application of the property's Involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and co <br /> r ect. <br /> c7 <br /> Print Name: c G <br /> Signature: 67, Da te: ? 1 b <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: ' <br /> I <br /> iI <br /> 1 <br /> i <br /> I <br /> k <br /> - r <br /> t <br /> f <br /> 10:03 AMPkLA08 Febr ry 1,iBB9 <br /> —4— <br />