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APPLICATION - LOT LINE ADJUSTMENT <br /> GA N JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> F <br /> FILE NUMBER: <br /> IFo <br /> ii AUTHORIZATION SIGNATURES , <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> i <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 /> u <br /> 1, 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 owners 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 /> „ <br /> Print Name: 660e"i 14, IN&I'1-AZ Signature; Dater v <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: " Signature: Date: r <br /> I <br /> y+ <br /> i <br /> i <br /> I <br /> ! <br /> I <br /> F:IDEVSVGTlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 8.4-04) <br /> �I <br /> it <br />