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APPLICATION - LOT LINE ADJUSTMENT . <br /> �+= < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> a FILE NUMBER: <br /> FO� <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN 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 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: �G gib, C k`t�.}'S O Signature: _ Date: y <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F-MEVSVOPlanning Application Fom,s% Page 5 of 7 <br /> Lot One Adjus"enf.doc.(Revised e5-11-09) <br />