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APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> gC1F...... .P FILE NUMBER: <br /> A`UTHORlZA7iON SIGNATURES <br /> ONLY THE OWNEROF THE PROPER-TY OR:ANAUTHQRIZED AGE'NT,MAY FELE 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 County arising from the Owner/Agent's project. <br /> I <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: P Signatuir e Date: 3-Z/ a <br /> Print Name: Signature: F <br /> Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> x <br /> F OEVSMPlanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />