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gk <br /> APPLICATION LOT LINE-ADJUSTMENT <br /> j SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ]FFILE 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 r <br /> 111 involved in this application, or ) p operty(s) <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 /> PrintName: i�� Signature: <br /> Date: 12 7 <br /> Print Name: Signatur <br /> Date: /� d <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date. <br /> Print Name: Signature: <br /> Date: <br /> RMEVSVOPlanning Application Fornsl Page 5 of 7 <br /> Lot Line Adjustment.doc_(Revised 6-3-03) <br />