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_ T LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COh1 MUNITY DEVELOPMENT DEPARTMENT <br /> g(x.1NdRIZXhON 1G1ViaTiJRPS' <br /> ' l7�Ntl�'�TifE'bW11��WF.7#^IlePl4C�A�R�!t�1�4�FaA[7'�7iE3�fZEt7flliaEN7'M6�4YFll.t�;$N;AfyPE:ICJITltJ1W <br /> ri.jrurther. <br /> wnerlAgent agree,to defend,lndenmlfy,and hold harm►ess the County and its agents,officers and employees from any claim,action or <br /> ding against the Owner/Agent's project <br /> certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer of the <br /> application,or ) p►oPefs)lrrvolved In this <br /> O Legal agent(attach proof of the owner's consent to the application of the Property's Involved In this application and have <br /> been authorized to Tile on their behalf,and that the foregoing application statements are true and correct <br /> Print Name: L 0 A riga Signature: <br /> Date: <br /> Print Name: `� C Signature: <br /> PHnt Mama. <br /> Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> .. f <br /> I <br /> y <br /> 10113 AMPk A99 Felwwy 1,1989 <br /> -9- r <br /> �I <br />