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APPLICATION - LOT LINE ADJUSTMENT <br /> w`• SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �IFOR� <br /> AUTHORIZATION 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 /> II her, certify under penalty of perjury that I am (check one): <br /> p7Legal 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: �MRIi ARL S. 1IL,:6r-d Signature: Date: ' <br /> Print Name: V60)N 0"- S, 1t—Lr,A Signature: Date: -"7' 2"1 ct <br /> Print Name: Y AiVVEET �` I t�.."vinr(� Signature: - •Ate/--_ Date: I - - Zat g <br /> Print Name: S�'RiA'Dl 2 k. Tw' 4np Signature: c / Date: 3 7 <br /> Print Name: Signature: Date: <br /> FADEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustmentdoc.(Revised 05-11-09) <br />