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41 <br /> { . <br /> APPLICATION - LOT LINA ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 am (check one): <br /> ® Legal property owners (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 andM L Vccorrect. �*^ <br /> Print Name: Bi nature:' Date: G d <br /> Print Name: r %.J♦ a 5i nature: <br /> Date: G <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> I <br /> F:IDEVSVCIPlanning Application Formsl) Page 5 of 7 <br /> Lot Line Adjustment,doc {Revised 6-04-04 <br />