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°P- c APPLICATION — LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `:c.._�_,•P/ <br /> � FILE NUMBER: <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 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: E Signature: Date: /D-.1Z4-� <br /> Print Name: Signature: J Date: C - 3o t, <br /> Print Name:lt Signature Date: <br /> Y.-^ <br /> Print Name: _ - „r�'"a� Signature: Date: <br /> Print Name: Signature. Date: <br /> F.IDEVSVC\Planning Application Formsl Page 5 of 7 <br /> Lot Line Ad)ustment.doc.(Revised 6-4-04) <br />