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+a E <br /> �• 4 i r <br /> y <br /> �urN APPLICATION _ LOT LINE ADJUSTMENT <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FOR�'� 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 Owner/Agent's project. <br /> I, further, certify under penalty of perjury that 1 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 /> application and have been authorized to file on their ehalf.,and that the foregoing application statements <br /> are true and correct. <br /> Q � <br /> Print Name: A/ TDA Signature: Dater <br /> T ' <br /> Print Name:QRrr�e 5Signature <br /> Print Name:`, 'aq I(-,P- i ejeYr t d/A Signatu e L. vk 'i-Tf-- Date: 5 <br /> Print Name: Signature, Date: <br /> Print Name: Signature: Date: <br /> POEVSVOPlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 64-04) <br />