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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ./ <br /> �y <br /> FILE NUMBER: <br /> IL AUTHORIZAMN'SIGNATURES <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 County arising from the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I em(check one): <br /> t� Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property($) <br /> involved In this application,or <br /> El Legal agent(attach proof of the owners consent to the application of the property's involved In this <br /> application and have been authorized to fife on their behalf„and th the foregoing application statements <br /> are true and correct, <br /> o uc <br /> Print Namn: G60ef �a{_ Signature: X_ / <br /> Data: <br /> Print Name: _ Signature: Date: <br /> PMnt Name: <br /> Print Name;� �Signature: e: <br /> Print N;f;aXy:-romyA� SirL9ElQG 7AU-,•"Signature: X Data: 5. o <br /> - hut NAME of ou1N62 7olJY� � CBE�G; As sv�c�3so� T�vsr <br /> DF TtFE J'Dlt/V TWOMAYS V#A) S4-N7'FN AlkU6 <br /> WII�N1>71 Mame- vl,� nl st}NT�nI REVO-491,,95' <br /> L4 V ING Tlzutr � �-v tTuN� /�} yolz <br /> r:toav$votri..09 ApWicaaan Farb\ Page 5 of 7 <br /> L01 urs AdlWfteMdac.(nevlseao5.tt-09i <br />