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N APPLICATION - LOT LINE ADJUSTMENT <br /> . ........ <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 00 <br /> /.••'Q.. FILE NUMBER: <br /> �!ti'r'6R" <br /> AUTHORIZATION SIGNATURES <br /> F=ONLYTHE 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 /> F, 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 /> Print Name: I5-DQ fZJ> A, MPCNA>O Signature: v � Date: I ZZ-1 !� <br /> Print Name: maCuRbd Signatur.. Date: [ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVC\PIanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />