Laserfiche WebLink
APPLICATION LOT LINE ADJUSTMENT <br /> �-0 <br /> V� '1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .a FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> i are true and correct. <br /> Print Name: Signature: <br /> Print Name:P <br /> fa s$ Signature: <br /> Print Name: A Signature: <br /> Print Name: .f e �r ti� ��-ra 4��c_&gnature: <br /> Print Name: Signature: <br />�I <br /> i <br /> FAIDEVSVC1Planning Application Formsl .Page 5 of 7 <br /> Lot Ling:Adjustrrent.doc.(Revised 05-11-09) <br />