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N <br /> APPLICATION - LOT LINE JUSTMENT <br /> I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN <br /> APPLICATION. <br /> 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 Owner/Agent's project. <br /> i <br /> f, further, certify under penalty of perjury that f am (check one): <br /> f <br /> Legal property owner(owner includes partner,trustee,trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> I <br /> L] Legaf 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 statement <br /> are true and correct. <br /> Print Name: Randal!Lange Signature <br /> Date: �r Q <br /> Print Name: Bradford Lange Signature: �_ <br /> Date: <br /> Print Name: <br /> 11Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> I <br /> 'r <br /> FA\DEVSVC\1Pianning Application Formsl\ Page S of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br /> n <br /> u <br />