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n uln. <br /> ALIGATION - LOT LII ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 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 I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> inMolved 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 Q�� <br /> Print Name: ScSA M e< ��/•��..�, � �^`�O ^a a Date: <br /> Print Name: V R'.— Eno P�X' w`L Bl�L1 IY>9nauve: <br /> Print Name: <br /> Prot Na G e- gna Date: <br /> PrkK Name: Slgnattue: Date: <br /> F:Zevsvtwi,rw*q Appk.don FomW Page 5 of 7 <br /> L lire MjRonM.dm(RMsed 64-01) <br />