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U.I.... <br /> APPLICATION LOT LINE ADJUSTMENT <br /> r ;{ SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4 <br /> FILE NUMBER: <br /> q�fFa•!t <br /> __....._ <br /> ' AUT.HQ�tI �'iON SICI��►T�J�LS . . _ _ _ <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 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: ., i,64 •I `� Alk 090k'S,_ Signature: -�`" '�- "��r 12 �J Dater t i i <br /> Print Name: J � Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSMPIanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />