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w <br /> .W <br /> LOT LINE ADJUSTMENT <br /> SAN JOA UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> A TN RIZATION SIGNAT RE <br /> ONLY THE OWNER OF THE PR PER Y OR ANAUTHORIZEDA ENT MAY 1 ILE AN APPL! ATl N. <br /> !, the Owner/Agent agree, to or, indemnify, and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> !, further, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner includes partner, trustee,grantor, or corporate officer) of the property(s)involved in <br /> this application, or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: SIA'E 1.S Signature: -71V �� {S�l�ft- Date: <br /> Print Name: �f ' 515&-- d <br /> L Signature: Date: 11 b j <br /> Print Name: - I/ nJ C(J'STr4 Signature: Date: <br /> Print Name: A �/� !�S Signature Date: <br /> Print Name: Signature: Date: <br /> F:DEVSER/:CAAF/?LAiAPPSi=LZNEAD APProm REV 2/1/99 —4— <br />