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z „. APPLICATION - LOT LINE ADJUSTMENT <br /> � .. <br /> c <br /> N � SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Bc.a��.• 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 County arising from 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 applic n of the property's involved in this <br /> application and have been authorized to file on their behalf., n that the foregoing application statements <br /> are true and correct. <br /> Print Name: th•(fAe( S'In0f1— Signature: Q Date: tt Ib IS _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature. Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F VEVSVC\ ienNng Applkalio0 Fom18\ Page 5 of 7 <br /> Lot Lime Adjustment doo (Revved 05-11-09) <br />