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:^- �r <br /> OT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,:. . AIJT}iOR17ATION SN3NATURE3,: _ <br /> ONLY TtfE OWNER OF-TI4E PROPERTY OR AN AUTNORWM AGENT MAY FILE AN APPLMJI <br /> 1 the Owne wAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against Me Owner/Agent's project <br /> 1,further, cerdly under penalty of perjury drat I am(check one): <br /> Legal property owner(owner'fncludes partner,trustee,trustor,or corporate officer)of the property(s)Involved in this <br /> application,or I <br /> O Legal agent(attach proof of the owner's consent to tie appiicadon of the property's involved In this application and have f <br /> been authorized to fila on their behaH.,and that the foregoing appilcadon statements are true and correct. <br /> i <br /> Prins Name: nature: 1(7,4Y1AivCHHa� Dare: <br /> s i �/�W�HHQ� Date: <br /> Print Name: Signature: <br /> Print Name: �'"`r� Signature: t N O Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 9 <br /> f <br /> i <br />