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APPLICATION - LOT LINE ADJUSTMENT <br /> {' SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> rop FILE NUMBER: <br /> Ll <br /> AWTH�ORIZATI,OI'SI:G'�NATU.RE'S rA} <br /> .ONLY TTHE:OWNER`OF,THE PROPERTY ORFAN'AUTHORIZED:AG NTEMAY;:FIL'E gAtV 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 propert)(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: UO T` Kl u C SignatureDate: `T 6' <br /> Print Name: t.u,r-7>fzA ?A 1-71 l Signature: Date:. 4fr1 106 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1DEVSVC\Ranning Application Forms% Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />