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} <br /> • ,c� ` ,�o APPLICATION - LOT LINE ADJUSTMENT <br /> z� <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • t4• FILE NUMBER: <br /> 7 1 AUTHORIZATION�SIGHATURES <br /> � ,v. <br /> % <br /> AMTHE OWNER,OF��TWE;pROPERTY OR>ANAUTH4RIZED'AGw NT�MA'YFaILE AiVAPPICATION. <br /> n _ w. _.. R <br /> MII" <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 /> 1, 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 /> 12 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. t <br /> Print Name: X GGl AV Signature: Date:[I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Mame: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />