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>sP �o APPLICATION — LOT LINE ADJUSTMENT <br /> .c <br /> q Z< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .,. `p. FILE NUMBER: <br /> 9�jFOR� <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 /> ® 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: 5TAAJLi—')1 kA L-h hrA L l5 Signature: Date:.S`-J'y�J <br /> Print Name: a L R�4a l Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F-.0EVSVC\Planning Application Forrns\ Page 5 of 7 <br /> Lot Line Adjustment.doc. (Revised 05-11-09) Project No.1326 <br />