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Sep 271312:59p 5419972666 p.1 <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> -. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> � ;. <br /> FILE NUMBER-- <br /> AUTHORIZATION <br /> UMBER: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. <br /> ���Prins Name: ��%��% Signature: <br /> Print Name: signature: Date: <br /> Print Name: Signature. Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signatures Date: <br /> ;6 <br /> FiDEvsvcWRa ning Appli.tl n roma\ Page 5 of 7 <br /> LN Lh+e�u5lmenLdO[.rnpviaetlOS11-0g) <br />