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n <br /> APPLICATIONLOT LINE ADJUSTMENT <br /> /.• •.ot <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �C:Fi7R? <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 Owner/Agent's project. <br /> 1,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 /> ❑ Legal agent (attain 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: �L�tl Signature' AIWA, Date; <br /> ` Y Si natu � Date: <br /> Print Name: / g <br /> Print Name: a e-s Signature: Date: <br /> Print Name: -? � Signature: <br /> Date: <br /> Print Dame: Signature: bbu& Date: <br /> w <br /> F_0EVSV0P1anrdng Application rte% Page 5 of 7 <br /> Lot Cine A4ushnemdac.(RWsW 64-04) <br />