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e. <br /> COT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT,DEPARTMENT <br /> Ad aarzarbN slGNiaF. <br /> ruREs <br /> ONLY TME::OYVNERpF77/E1?RGPEli71 QR%INAt17HdRlZEDAGENFMAYPILERN.4PPLlCATION. . <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penally of perjury that 1 am(check one): <br /> O Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the propeny(s)Involved In this <br /> application,or <br /> d Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application and have <br /> been authorized to file on their behalf.,and that the foregoing application statements are true and correct <br /> Print Name: ter -'M i-rll Signature: Date: <br /> Print Name: ..Md e-ToMl�. SN!/.�d� _ Signature: rt4, Date. <br /> Print Name: Signature: .._-- Date: <br /> Print Name: Signature: _ - --- „ .. Date: <br /> Print Name: Signature: Date: <br /> i <br /> I <br /> i <br /> i <br /> fi <br /> 10:03 AMPkL 1%8 Fsdw.ry 1,1890 <br /> -9- <br />