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f � <br /> Z. °u�" APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `•.. - FILE NUMBER: <br /> Qti�oa� <br /> AUTHORIZATION SIGNATURES <br /> i rremployees <br /> E OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> er/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> from any claim, action or proceeding against the Owner/Agents project. <br /> ertify 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 /> I application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Signature: date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> t <br /> I <br /> M <br /> F:%DEVSVGIPlanning Application Farms% Page 5 of 7 <br /> p Lot Line Adjustment.doc.(Revised 6-4-04) <br />