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[' �. .7 <br /> APPLICATION LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> cFILE NUMBER: <br /> 9 I <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> f I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> Legal property owner (owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and have.been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> �f b <br /> Print Name; Q�f3' iWl� Signature: Date: /O!/✓r 4 f <br /> Print!Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: i <br /> Print Name: Signature: Date: ; <br /> I <br /> i <br /> I <br /> I <br /> FA0EvsvC\P18nning Application Formsk Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) 7� <br />