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LOT LINE ADJUSTMENT <br /> SAN JOAQULN COUNTY TY DEVELOPMENT DEPARTMENr <br /> "ZTIQN SIGNATURES <br /> ONLY THE OWNER QE W9 P-Ri2PERTY 011 AN AUTHORIZE0 AGENT MAY Fla An APPUCATION. <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the OwnerlAgent's project. <br /> 1,further, certify under penalty of perjury that 1 am(check one): <br /> 6 Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> O Legal agent(attach proof of the owners 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 /> Pril�tNalrle: Barbara J. Due Signature: 4 �`-- ,� Date:2-1$-04 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> • e <br /> Yi DtVs£R/IWaKKIPLAHAPP9/LOTLIHEAUJAPPFORM REV 2/1199 —4— <br />