Laserfiche WebLink
APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <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 /> I, further,certify under penalty of perjury that I am(check one): <br /> 0 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 /> Ooualas P. Bruhns iignatu e' `r ''`t a' ✓ J,� Dace: 12122/15 <br /> Print Name: <br /> Print Name: prf/S /t"� Si �Signature: T.f -%f'"' ,•�_ bate: /�. /f <br /> Print Name: _ :signature: Date: � <br /> Print Name: Signature: Date: <br /> Print Name: signature: Date: <br /> F:1DEV8V41P1ann1nq Applicn1W Formal Page 5 of 7 <br /> LM Llne Adjuslmr,nl.dm,(11 v1& 0 05.11.09) <br />