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v? <br /> r)T LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> u <br /> 1,the Owner/Agent agree,to defend,tndemnffY,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, cerilly under penalty of perjury that I am(check one): <br /> 0 Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> appikattom or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and have <br /> been authortzed to Hie on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: iVli--��FLIIt�It-z- 141) r L Signature: IDate. <br /> ag4i�� --Date: -1 Zq I <br /> Print Name: N I i aa 6..R 0 2 At do Signature: <br /> Print Name: Signature. Date: <br /> Print Name., Signature: Date. <br /> Print Name: Signature. Date: <br /> -4- <br />