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aPa lY APPLICATION — LOT LINE ADJUSTMENT <br /> °< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • P FILE NUMBER: <br /> 4Cfc0_N <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 County arising from the Owner/Agent's project. <br /> I, further,certify under penalty of perjury that I am (check one): <br /> ❑X 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 /> Print <br /> orrect ^, <br /> Print Name: k l R 4roi Signature: Date: -Zi <br /> T <br /> Print Name: Co/bP_��R k^ Signature: �� Date:-2 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVCTIanning Appri flan Forms\ Page 5 of 7 <br /> Lot line Adju nent.do (Revised 05-11-09) <br />