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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 /> [� 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. n rl <br /> Print Name:5p0t)!f 15H uj tl A t R�P fVeAgnat�e`. Dater 2 I� <br /> Print Name: h�5 I� F�'y V�15(oRQ Signature: Date: Z 17 <br /> --� INv G STµEN7�CP�• <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> Print Name: Signature: Date: <br /> 0W"EaG c <br /> R �rJ l°t3 - <br /> ISA-a•r�E25MiP . <br /> 2g4,o W. MARCH W SFE zzv <br /> Ptil ST-D e-.cTod, CA . q5 2I 't <br /> VA•scop- In s, uESTxF -5 Co7pp ., q— <br /> CA-Lip. Cot oa.4,.owl . <br /> A_o . BOX ac+4-z <br /> STae-l--r-DA-J( 6.4- . 47 szog <br /> F.ADEVSVCTIanning Application Forms\ Page 5 of 7 <br /> Lot Line Ad)ustment.doc.(Revised 05-11-09) <br />