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u <br /> S <br /> APPLICATION — LOT LINE ADJUSTMENT <br /> { SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4c'iFOR��P FILE-NUMBER: <br /> '� �..}E•2fh�,flF� „y k ;ec: � 2 fi��':! �' k��}Y'f ''^`x g. Z �,�.7S tit--3t f� - <br /> ,�OWNER,i ` k_ <br /> ONLY THEA EMIRPROPERTY'OR ANEAUTHOREZED_AG,ENT MAY,FILErAN,gPPLIC'ATfON <br /> l the :Owner/Agent agree, to defend, indemnify; and hold harmless the County •andyits.agents, .officers and <br /> erhployees 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 /> Legal property owner (owner.includes partner, trustee, trustor, o orporate officer) of the property(s) . <br /> involved in this application, or <br /> [] Legal'agehf(atfach proof of the owner's consent to the app ation of the property's-involved`in this <br /> application and have been authorized to file on their beha -, and that the foregoing application statements <br /> are true and correct. <br /> t <br /> Print Name: Signature: Date: l l <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> F:\DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Lot Line Ad{ustment.doc. (Revised 6-3-03) <br />