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APPLICATION - LOT LINE ADJUSTMENT <br /> 11-441 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 1 , <br /> ' FILE NUMBER: <br /> '�CIFORF <br /> AUTHORIZATION SIGNATURES <br /> IFONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> . 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: 3,r zxf�L-r V05 - _ Signature: Date: <br /> Print Name: J—!j A e-#& �. ��U Signature: Date: <br /> Print Name: DeT34A A-tJ&S5C--1--J Signature: I �`' Date: �7 <br /> Print Name: _U'��+rFSS�1y Signature: �. / Date: D <br /> �� 9 <br /> Date: <br /> Print Name: - ,aL <br /> Signature: a : <br /> Nawru <br /> FADEVSVMPIanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6.4-04) <br /> I <br /> i� <br /> I <br />