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R , <br /> ff, <br /> kj Q�gUfl�. C •.:., <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> fir,,=r <br /> np vS 2 s+k"-+ d _ ' V " .Tv ` �ti► �s\ Ai7h-y, 'wl� .'-q ,i�r,g `a; ia ;Si s. Q <br /> E <br /> `: ...t'"�i4.`31? `s Y '`a�1:4,g?'�,����;.t� 9 `�z'� '-gY��p. �+ �'�..�'+Y,,��'c.p:� � "`w� t � � ts, s .'.l� �F �a n.;: r 4. , 2::•;„-. <br /> bNLY Ti�iE(�3'U17NE1(��F��HE�P,, t�pERT'���Alf.,�l`�i'�##O,��E�:.�IG�N�,M�►'Y�'IL:��AN,APRL�CA (i�N <br /> tsrd- <br /> 1, 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 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 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 correct. <br /> Print Name: P= Signature: Date: <br /> Print Name: Signature: �4,- ) Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature. pate: <br /> k <br /> I <br /> Ei <br /> k <br /> i <br /> Ei <br /> E� <br /> �1 <br /> U <br /> i� <br /> E <br /> Ei V <br /> F:{DEVS1lCLPtennirkg AppllCation Formsl Page 5 of 7 <br /> tot tine Adjtistmentdoc.(Revised 6.4-04) �O<D <br /> I <br /> f <br /> .i <br />