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�. APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1. the Owner/Agent agree, to defend, Indemnify, and hold harmless the County and its f <br /> agents,ents, officers andemploYfm any claim amon or proceeding against the Owner/Agent's <br /> 1 pro'ect. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> f ❑ Legal property owner(owner includes partner, trustee, trustor or corporate <br /> involved in this officer)of the property(s) <br /> 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 and oorrect. <br /> �- <br /> Prirrt Name: r c(roa au, d v Signature: <br /> Late: <br /> Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> Print Narne: Signature: <br /> Print Name: Signature: <br /> Date: <br /> s <br /> P <br /> I <br /> P OEVSVC1PIs Wng gypka*m Fwm \ Page 5 Of 7 <br />