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r <br /> Q.-l. <br /> APPLICATION -. LOT LINE ADJUSTMENT <br /> SAN JOAQUiN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> f1the <br /> LY THE OWNER Or pie PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 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 /> t <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 pro e s <br /> involved in this application, or P rty( ) <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved i <br /> n this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. r <br /> Print Name: j1 j �� �4/ Q <br /> Signature: nate. - _� <br /> Print Name 6I r� /F � � j <br /> Signatur Ly_ <br /> Print Name' Date:_� ! ,� <br /> Signature. <br /> Print Name: Gate: <br /> Signature: <br /> Print Name: Date, <br /> Signature, <br /> Date: <br /> I <br /> FADEVSVCV1ann1ng Appiicatlon Formsl <br /> Lot Line Adiu oment doo,(Rsv%ed 5.4.04) Page 5 of 7 <br /> Z9/ZE 3E)Vd 9NTA74ANnc; f w"-i eAnni4q 71QTrCPFQ7 CC't T 0007 Ir-T/)a <br />