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APPLICATION ® LOT LINE ADJUSTMENT <br /> ,,. _ ., ; I I SAN JOAQUL4COUNTY,OrJMMU^!ITYl1EVELOPt4EMT.UEPARTMEXT <br /> FOR{ <br /> :j FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> ONLY OF THE 7'Y`On AN Aa3Sti ED A{iE j WAY FI E AN <br /> , <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its ndemployees from any claim, action or proceeding against the County arising from the Own .I,further, certify under penalty of perjury that 1 am (check one): <br /> Legal property owner(owner includes partner,trustee,trustor, or corporate officer)of <br /> ` Involved in this application, or <br /> El Legal agent(attach proof of the owner's consent to the application of the propertys 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: V )A ,)gamSignature! <br /> _ <br /> �. �'/ evL ture; Date: U <br /> PrintNatae:. 0GA6Aieg91 Date:. <br /> Print Name: r t^ Signature; _ Data. <br /> Print Name: Signature: Date: <br /> Print Name: signature: Date: <br /> "hDEVSVOI-lanning Applkation Forms) Page 5 of 7 <br /> Ca Line AdjustmenLdac.(Reviseo 0&1 t-OB) <br />