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�3 APPLICATION -- LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUT_HORIZATION'SIGNATURES <br /> ONLY 7HE OWNER.OF THE PROPERTY OR AN AUTHORIZED AGENT,MAY FILE AN APPLfCATION. }.A <br /> i <br /> f, 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, further, certify under penalty of perjury that I am (check one): <br /> t4 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 /> r <br /> Print Name; `S Ir' Signature: <br /> Date: —0.06— <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: <br /> Date: � <br /> Print Name: Signature: Date: <br /> I <br /> I' <br /> 1 <br /> I' <br /> FADEvsvcsPianrnng AppficaUan Forms Page 5 of 7 <br /> Lot Line Adjustmen[.d0c.(Revised 6-4-04) <br />