Laserfiche WebLink
u!ty APPLICATION -' LOT LINE ADJUSTMENT <br /> ENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .•�dcf 4 `�.. FILE NUMBER: <br /> xR � AU711DF ATt N SIGNA7`1lRE� � <br /> r <br /> Yat3y n ick' <br /> , °'fi '':' � '" ,G Y s;n� <br /> ONLY THS aWNEF�OF,YHI:,PFI<OPERTY Ofd AN:AUTHORIED AGEI+IT Ml►Y.FILA*pN LIQ Th' <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 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 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 /> rPtint <br /> ame: el?� l'��� ^_ Signature: <br /> me: �ffi rasSignature: Date: <br /> ame: Signature; <br /> Date; <br /> Print Name: - <br /> Signattire: ' - -- . . . . _ . . . . <br /> Date: - <br /> Print Name: Signature: <br /> Date: <br /> i <br /> POEVSMPlanning Applicatlon Formsl Page 5 of 7 <br /> Lot Lina AdjustmeW,doc.(Revised 64-04) <br />