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APPLICATION - LOT LINE ADJUSTMENT <br /> X SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> C'fiq FILE NUMBER: <br /> AUT N51 <br /> E <br /> :..r <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 an <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 /> ER 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: �J' 1129M!E') Signature: ­.0.1 Date: <br /> Print Name: jr ;f4, 7,e4r-1- Signature: U Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> s <br /> I <br /> FA DEMC Wlanning Application Forms%\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-0-04) <br />