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r°- l 1 <br /> LOT LINE AD,JUSTMEN" <br /> SAN OA UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `v <br /> 1,jthe Own Ag agree, to defend,Indemnify,and hold harmless k <br /> s the <br /> Coin <br /> ntand its a encs <br /> V g ,o rcers and e <br /> fl ff mpla ees from an claim.rai <br /> .f V m,action <br /> or proceeding against the Owner/Agent's project. <br /> 1,l further,certify under penalty of perjury that 1 am(check one): <br /> 0 X Legal property owner(owner includes partner, trustee, trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have <br /> been authorized to file on their behalf,and that the foregoing application statements are true and correct <br /> Paint Name: <br /> Signature: Date: <br /> ta- 3 -� <br /> Print Name: Signature: <br /> A Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> JJ Date: <br /> �3 <br /> 11 <br /> r <br /> i <br /> 5 <br /> I <br /> ! <br /> 5 <br /> 1 <br /> ! <br /> .4_ <br /> f <br /> 1 <br /> 5 <br />