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C,�i—kU APPLICATION 11-40 <br /> LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> q, <br /> q 7--iU, <br /> INJA' 100 Oil' <br /> bN <br /> 1, 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 /> 1, 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: A(OK 40hrQY) Signature: <br /> 4 <br /> Date: <br /> /— <br /> Print Name: jak? fSignature: <br /> Print Name: Signature: <br /> Date: I,Z# <br /> Print Name: Signature: Dateate <br /> :- <br /> Print Name: Signature: Date: <br /> p_ <br /> FADEvsvmplanninq Appllcsfion Fo"s% Page 5 of 7 <br /> Lot Une Adjustmenttim(Revised 05-11-09) <br />