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' ={-• L�LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEIIELOPML NT I) PARTMENr <br /> Mlnafwariil�s <br /> k �',. ..,-' ONLY77�ff'OWIVSRQ1��71iEPR�Di�'R1'1'pR�I1CITNORI�GA4st«]V7`MAYFlI:EAhF AAPLIG`A7it7�if,- � ' <br /> iM <br /> 1,the Owner/Agent agree,to deflk4 IndamMfy,and hold harmless the County and!ts agents,officers and employees from any claim,action or <br /> proceeding agalost the Owner/Agenrs project <br /> l <br /> 1,farther, certfty under penalty or perjury that 1 am(check one): <br /> O Legal property owner(owner Includes partner,trustee,trustor,or corporate officeloferopeKy(s)Involved In this <br /> application,or <br /> O Legal agent(attach proofofthe owners consent to the appllcatlon ofthe pro d In this application and have <br /> been authorized to file on their behaff.,and that the foregoing appllcadon are true and connect <br /> Print Name: r7+�/ .1�— L7 a✓A Signature: Date:4. <br /> Print Name: �c 1 y f.Jt-,,-fG„ Signature: to: '2-//6�Z•y/ <br /> i� <br /> Print Name: Signature: ate: <br /> Print Name: Signature: to: <br /> i . <br /> k <br /> Print Name: Signature:' Date: <br /> r. <br /> It <br /> i1 <br /> I <br /> I <br /> i <br /> �I <br /> � ioosnww�t�6`Pwuryt,tYw _q_ <br /> N <br />