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v APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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 /> 1,further, certify under penalty of perjury that I am(check one), <br /> ;Q 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 owners 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 n Signature: Date: I+— <br /> Print Name: k$V �1 ` t S _ Signature. Date. <br /> Print Name. Signature. Date:_ <br /> Print Name _ Signature Date <br /> Print Name: Signature: Dale: <br /> QEVSVGF1*n-1n9 AW—W Farms. Page 5 of 7 <br /> _a unaadiuetmentdM(Reseed 05.11,J9, <br />