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_ <br /> APPLICATION _ LOT LINE ADJUSTMENT <br /> � SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �<_;fioRa`i FILE NUMBER: <br /> a <br /> AUTHORIZATION SIGNATURES <br /> :6 <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> 1, 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 /> i <br /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this <br /> application and haveCbeen authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> 1 <br /> Print Name: i ]G,M ]ne Signature: :�i Date: 3 r Og <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.IDEVSMPianning Application ForrnM Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br /> i <br />