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APPLICATION - LOT LINE ADJUSTMENT <br /> ENT <br /> F. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTO 1('�RIT1aN S1�IVAT7177 <br /> RES, Y <br /> ONLY',THE OWNER O!=THE PROPERTY OR ANyAUTHQR Ep A`�ENTMAY I=1LE AN APPLiQATI©N-: <br /> fthe 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/Agents project. <br /> 1, further, certify Lander 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: O 1e Signature: <br /> Hate: <br /> Print Name: E e0A fit,T e Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signa: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> RMEVSVOPianning Application Fonnsi Page 5 of 7 <br /> Lot Line AdjustmenLdoe.(Revised 6-4-09) <br />