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APPLICATION - LOT LINA ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> _ FILE NUMBER: <br /> •,FIFO ! - ` <br /> . . AUTHORIZAT.10�'Sf`G`_NATU:RES <br /> ONLY THE OWNER OF-THE PROPERTY+DR AN`AUTH_O,RIZED AG,ENT'MAY FILE.AN APPsLICA'f10N <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 /> 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(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: oA\ � Signature: Date: `� •-Z—� �� <br /> Print Name: b W N Signature- Date: <br /> Print Name: D O.l Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVG\Planning Application Forms\ Paae 5 of 7 <br />