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�Utk APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />. o4C7FF•�i�`P <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES . <br /> _'. [ >, '� '1 s ,` _r •a: 8 rl : - ... '`' t [ • 3- iii E k ¢S x x <br /> :, .... .^ <br /> QNf_Y THE'O.WNER;OF THE PROPERTY OR'AN,AUTHOM21ED 4GENT MAY' ILE 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 Owner/Agent's project. <br /> 1, further, certify under penalty of perjury that I am (check one): <br /> tr/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 Name: L S signature: Date: <br /> Print Name: -r_j E l44 rn 'T .S Signature: Date: t— <br /> Print Name: Signature: Date, <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FMEVSVMPlanning Application FormM Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />