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LOT LINE ADJUSTMENT <br /> jAyj AQ ►N O TY MMUNITY DEV LOPMEN�DEPAR EN <br /> IZATIQN MA <br /> E <br /> APPLICATION, <br /> 1,the OwneriAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the OwnerlAgent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> ,6. Legal property owner(owner Includes partner,trustee,grantor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> O Legal agent(attach proof of the owner's consent to the applIcatlon of the property's Involved In(his application and <br /> have been authortred to We on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: ,Q / '�U r� vA Signature: Date: 0—/9 <br /> Print Name: ,t 11 \4 t l� �1� Signature: Date: IpL <br /> Print Name: Signature: Date: / <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />