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Pq ® 0400799 <br /> - APPLICATION - LOT LIA ADJUSTMENT <br /> y< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> d P FILE NUMBER: <br /> trpos�� <br /> AIJTHORiZATI®N $1-NATURES <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from arty claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify ui ider 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 (aj;ach 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 NamQ: _ E Signatur Date:129-22-61 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEMC\Planning Applicatiw Forme\ Page 5 of 7 <br /> Lot Line Adjuelment.doc.(Ravi&d 64-04) <br />