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APPLICATION - LOT LINE ADJUSTMENT <br /> y� SAN JOAQukN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �Ll F'OR� <br /> � AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the OwnerlAgent 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 /> 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:40 T Signature: Date: <br /> 7--/ <br /> a <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> k <br /> #F�AU�EVSVMPlanning Application Fonnsl Page 5 of 7 <br /> 1LDt Line Adjustment.doc.(Revised 6-4-04) <br /> ` Amfilm,111116 _ -- <br />