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'�AauIN APPLICATION - LOT LI <br /> NE ADJUSTMENT <br /> ;2 <br /> j' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> I <br /> AUTHORIZATION,.S,IG�NATURES <br /> ffONLYHE QWNER OFTHE PROPERTY.-:ORAN"AUTHORIZED AGENT_MAYF1LE AN APPLICATION. <br /> , ewner/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 true and correct. <br /> Print Name: Ar Signature: Date: -43-D <br /> Print Name: Signature: Date.- <br /> Print <br /> ate:Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FiTEVSVC\Planning Application Forms% Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />