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APPLICATION LOT LINE ADJUSTMENT <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �•.�. ,� �p• FILE NUMBER: <br /> �L�FOR� <br /> _. _..._ <br /> Aura-Eo l o s G-M FW <br /> ONLY THE OWNER OF THE PROPERTY OR;AN AUTHORIZED-AGENT MAY:,FILEAN APPUCATION <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: r� L_ if U5`1 Signature: Date: t i <br /> ---- F 7 i <br /> Print Name: `�ttf':FZ�1�� ��. i{._:s�..�:. Signature: �,r�;� � Date: �,�,�`• 1 � <br /> Print Name: Signature: a Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> L- <br /> F\DEvsvmPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adi'usiment.doc.(Revtaed 8-4-04) <br />