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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION,,SIGNATURES ; <br /> ONLY THE OWNER OF THE PROPERTY.OR AN:AUTHORIZED,AG.ENT MAY:FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action 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 <br /> this application, or <br /> Legal agent (attach proof of the owner's consent to the application of the property(s) involved in this application) <br /> and have been authorized to file on their behalf and that the foregoing application statements are true and <br /> correct. <br /> Print <br /> Name: Marvin Deft Dulk Signature: Date: 1 <br /> PrintA��, # <br /> Name: Edith Den Dulk Signature: Date: l.2 — <br /> I <br /> i <br /> E <br /> 1! <br /> t <br /> FOEVSVC/Pianning Application Forms/ <br /> Lot Line Adjustment doc. (Revised 06-04-04) Page 3 of 3 Job No 2004-221 <br />