Laserfiche WebLink
( <br /> LOT LINE ADJUSTMENT <br /> t <br /> SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> k 'Y b8 F3 't1 g"� A1�,E�1OI�I�.rV�itiw!'Rf1G (. C.]:nor'`".- :'4. ?' d ;.,1wR� : h;a'M '✓', .,mo-.r4aRSd.L"`.4"3'y °R 3 } �':e: <br /> ,f3NLYTHE-OWNER'QFTHE,POPEFiTYORAN�A�1TlilwJF1L�ED%1Cit`NT�IIAIf,.CLEAN+4PPLIGA7iON,�, ..,�,;i'; ';„�,� <br /> 1,the Owner/Agent agree,to defend,indemnity,and hold harmless the County and its agents,officers and employees,from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> I,further,certify under penalty of perjury that I am(check one): <br /> X Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)involved In this <br /> application,or <br /> Legal agent(attach proof of the owner's consent to the application W.the property's involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: ` 1bE (c` Signature:` Date-, D' <br /> Print Name: Sigaature: Date: Q <br /> Print Name: a �! t /✓2 ',2t' Signature.• <br /> Date: 1c/� �' <br /> ��I! • � <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> k <br />