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' c° APPLICATION — LOT LINE ADJUSTMENT <br /> ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 9�%F O•F�\P FILE NUMBER: <br /> 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 /> 1,, further, certify under penalty of perjury that I am (check one): <br /> E( <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 /> Print Name: UOVA N 'T21.3We Signature: S <br /> Date: Q/ <br /> Print Name: A SIS PAL Ph a J Signature: <br /> 1 � ' Date: " Z <br /> Print Name: ��_.,��, �e? a-.-ic —`'rt t ti�i� �� <br /> --pp Signature: Date: / <br /> Print Name: _I�O}�Q{'•}— ��j ►� Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> FADEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />