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>.. .�Q APPLICATION -- LOT LINE AD <br /> JUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> I <br /> AUTHORIZATION SGNi4TURES <br /> �:7 <br /> ONLY THE OWNER OF THE PROPERTY OR'AN.AUTHORIZED AGENT•MAY;FILE AN'APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, a <br /> nd hold employees from any claim, action or proceeding against the Owner/Agent's project ss the County and its agents, officers and <br /> I, further, certify under penalty of perjury that ! am (check one)- <br /> FE <br /> ne); <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 /> i Print Name: NSc*-�Gignature: C <br /> Date: 3 l3` o—f- <br /> Print Name: <br /> Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> i Date: <br /> i <br /> i <br /> r <br /> F:IDEVSVC\Planning Application FormM Page 5 of 7 <br /> Loi Line Adjustment.dac.(Revised 6-4-04) <br />