Laserfiche WebLink
"P=te A APPLICATION - LOT LINE ADJUSTMENT <br /> �yi 1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> K FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <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 /> 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 trueandcorrect. <br /> Print Name: -3NA?;Ae2 //w/0,74w Signature: Date: 1 !1 <br /> Print Name: Signature: -ham � �Tw.�i'. Date:� L <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:OD SVCS Wnnir Applc im Fo M Page 5 of 7 <br /> Wt UM AdjuSi t.d .(Reused 64-04) <br />