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is <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> �..•�-.oma I <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> • ���l�-Q�N`�.• II <br /> i1 AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I <br /> I, the Owner/Agent agr Vie, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the OwnedAgent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> i <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 an rrect <br /> Print Name: ���� � Q��$�g <br /> nature: C . Date: <br /> Print Name: Signature: Date: 0 <br /> N� I <br /> Print Name: /�(� � Signature: Date: 5 <br /> Print Name: I Signature: Date: <br /> Print Name: Signature: Date: <br /> it <br /> i <br /> ! <br /> i <br /> 3 <br /> ;I <br /> II <br /> I <br /> 1� <br /> i <br /> F:1DEVSVC%Planning Application Form!I <br /> 1 Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4,14) <br /> M 'I 3 <br />