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R ��G APPLICATION - LOT LINE AD <br /> JUSTMENT <br /> a' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> s ��ko.• :� FILE NUMBER: <br /> f <br /> i <br /> AUTHORIZATION SfGNi4TURES. <br /> ONLY THE OVIINER QF THE PROPERTY OR AN AUTNOR�ZEiD,AGENT MAY FILE AN-M.PtIld,', - ON. <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 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 /> Print Name:,%A �ar Signature: Date: to 410 '!d <br /> Print Name: Ql / r7N G8 Signature. /11 bate: _A0_I d <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> i <br /> i <br /> F:1IDEVSMPianning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />