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)T LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTYOR AN AUTHORIZED AGENT MAYFILE AN APPLICATION. <br /> 1, the OwnerlAgent agree, to defend,Indemnity,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 /> 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)Involved In this <br /> 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 have <br /> been authortzed to file on their behalf„and that the foregoing application statements are true and correct <br /> nn <br /> Print Name: '00, /- , Signature: Date: Z47 U/ <br /> /� <br /> Print Name: �L1.t�L-L—af A , Luz Signature: LAY��.tns- l,<- �tl.-'L.�/ Date: Pi '1 c,♦ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> t0 W M1PI�UBB F�Fnury I,i BBB <br /> _a- <br />