Laserfiche WebLink
A7rPLICATION - LOT LINE�ADJUSTMENT <br /> SAN JOAQU€N COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> SIGNATURESAUTHORTZATION <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 Owner/Agent's project. <br /> 1, 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 statement <br /> are true and correct. <br /> Print Name: _&dV,1, (r 1> J. &AE C Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> I <br /> I <br /> FM1)FV5VC11PIanning Application Formsll Page 5 of 7 <br /> Lot Line Adjustment_doe_(Revised 6-4-64) <br /> .I <br />