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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAt?UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> 1 � r <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the OwrteriAgent 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 /> 1, further, certify under penalty of perjury that I am (check one): <br /> ❑ Legal property owner(owner includes partner, ee, 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 /> applk;aWn and have been authorized to file on the`r behalf., and that the foregoing application statements <br /> are true and correct. r <br /> i <br /> I <br /> ii f N u <br /> Print Name: ,,�.c, �f,, Signature: Data: <br /> Print Name: e a'!u cry/a v Signature: Date: s5l3lz9-7 <br /> Print Narm: Signature: Dom: <br /> _r 4 <br /> Print Name: Signature: Date: <br /> Print Name:. Signature: Date: <br /> EI <br /> EI <br /> li <br /> I r <br /> i� <br /> U <br /> �i <br /> 1 <br /> F:�rusvc, Applknwnormal Page 5 of 7 <br /> k rY 1�8�u1m�nl elrr IRnuhcprl fi.dd161 <br />