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R <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9OcoRN� FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> Fff <br /> HE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> ner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> s 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 /> 7 <br /> Print Name:�f {/ �l1pn Tr-a,, Signature: �l Date: —I —I <br /> Print Name: faQ- s Signature: Date: <br /> Print Name: I z Signature: Date:Print Name: Sin - i ct C�,l C Signature: Date:CI7� <br /> Print Name: fc \af an� Signature: Date: — �2 —( l <br /> FADEVSWOanning Application Fonsl Page 5 of 7 <br /> , Lot Line Adjustment.doa(Revised 05-11-09) <br />