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Lit <br /> ,.. , .c° APPLICATION - LOT LANE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ti <br /> <ii oRT'� FILE NUMBER: <br /> E <br /> AUTHO'RIZATiON SIGNATURES.. <br /> ONLY THE OINNER:.OF THE PROPERTY.OR',AN.A.tlTHORiZEID'AGENT MAY FlliE AN.APPLICATION. <br /> 1, the OwnerlAgent agree, to,defend, indemnify, and hold harmless the County and its a <br /> employees from any claim, action or proceeding against the Owner/Agent's project. gents, officers and <br /> t <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owni r includes partner, trustee, trustor, or corporate ora#e officer <br /> involve I P } of the property(s) <br /> e <br /> d m this application, or P P rtY(S) <br /> ❑ Legal agent (attach proof of the owner's consent to the appli a ' n of the property's involved in this <br /> application and have been authorized to file on their behal d that the foregoing application statements <br /> are true and correct. <br /> Print Name: <br /> Signature: Date: �0(,, <br /> Print Name: Signature: <br /> j Date: <br /> Print Name: 1 Signature: <br /> j Date: <br /> Print Name: t Signature; <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> F-OEVSVC1Planning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 5-3-03) <br />