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f <br /> -- Ai-PLICATION - LOT LINE�h► DJUSTMENT <br /> fa SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> _.. . <br /> ONlY THE OWNER OF THE PROPERTY OR AN AUTHORIZED,AGENT MAYI <br /> F <br /> 4 _ <br /> !E AN APPIIICATiON: <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 Owner/Agent's project. <br /> i 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 /> Lar <br /> gal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> plication and have been authorized to file on their behalf., and that the foregoing application statemente true and correct. <br /> Print Name: U-21 L Lt AM ja i'frV sO� Signature: /s <br /> • Date; IG 16,6 <br /> Print Name: <br /> 1�/-� 5 �• /71[�_1• � Signature: Date: ' <br /> Print Name: Signature: Date: i <br /> Print Name: Signature: <br /> i <br /> Date: , <br /> Print Name: ? <br /> Signature: Date: j <br /> r <br /> I <br /> FMDEVS aTianning Application Formsll Page S of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />