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I z . <br /> A + <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •. FILE NUMBER: <br /> j'Fo'a• <br /> f <br /> ONLY,.THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 /> IO/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; g�'[� Signature: Date: <br /> Print Name: Signature: 7,t2Ks7.e e, Date: <br /> Print Name: l Signature; Date: <br /> I <br /> i <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> i <br /> FA\DEV5VC\1Planning Application Forms\\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6i-0-04) 6 <br /> I <br />