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r <br /> —A. s A <br /> t y <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> .Foggy <br /> AUTHORIZATION SIGNATURES <br /> 7 <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZE© AGENT MAY FILE AN APPLICATION. <br /> t E: <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 /> J <br /> il, further, certify under penalty of perjury that I am (check one): <br /> E <br /> ® Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> 0 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:-ffeilet7 LGty.-li !� Signature: � ����"�_ Date: -000 <br /> Print Dame: Signature: Date: <br /> f+ <br /> Print Name: Signature: Date: <br /> E7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> E' <br /> } <br /> ii <br /> i <br /> 4 <br /> 1 <br /> i F:VDEVSVC%Planning Application Forms\ Page 5 of 7 <br /> t Lot Line Adjustment doe,(Revised 6-4-04) <br />