Laserfiche WebLink
oP4�•�"r•'� APPLICATION -- LOT LINE ADJUSTMENT <br /> c� <br /> ` <fI SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: --------------- <br /> Qt7Ko¢.?3. <br /> AUTHORIZATION SIGNA'T'URES <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 /> Fx] Legal propertyowner(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 /> _.. . <br /> Print Name: Q. `} 1 A Signature: , � • ,IL Pkn <br /> Print Name: Signature: or Date:-------------- <br /> Print Name: _ Signature: Date:_____ ------- <br /> Print Name: Signature: Dale:______________ <br /> Print Name: Signature: Dalai___-_______ <br /> F9DEVSVCtPlannin3 Application Forms't Page 5 of T <br /> Lot Lim AdrustmerAdm(Re&ed <br />