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LQ,T LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> IONSIGNATURES <br /> AUTHORIZATI <br /> ONLY THE OWNER OF THE PROPERrY OR AN AUTHORIZED AGENT JWAYFILE AN APPUCAMN <br /> 1, the Owner/Agent agree, to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. 1 <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)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 <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> g g AA <br /> j <br /> Print Name: e Zvice Signature: `�?7- �,r Date: <br /> Print Name: ,; Signature: + Date: s7f/2A/nl <br /> i <br /> T. <br /> e: <br /> 5Lt S AnL <br /> Print NamP£ _ Signature: ate: V ao O i <br /> I <br /> Print Name: Signature: Date: <br /> Print Name; Signature: Date: <br /> I <br /> i. <br /> f� <br /> �I <br /> �I <br /> I' <br /> ; <br /> i, <br /> � t <br /> , s <br /> I� <br /> j , <br /> �I <br /> I <br /> j: <br /> � E <br /> I <br /> 1:11 PMPA_LABE February 1.1999 <br /> '4- <br />