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a� <br /> LOT LINE ADJUSTMENT <br /> i <br /> 5 A IN O C MUNiTY DEVELOP EN DEPARTMENT <br /> AU p F i <br /> rcortify <br /> ree, to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> he OwnerfAgent's project. <br /> er penalty of perjury that l am(check one): <br /> Legal property owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s)involved in <br /> this application,or <br /> O Legal agent{attach proof of the owner's consent to the application of the <br /> a prcstatements ed In his a pplicaticarne=n and <br /> have been authorised to file on their behalf.,and that the foregoing application <br /> Print Name: <br /> Wt Zbu r Signature: pate: <br /> Print Name: <br /> Signature: Date: <br /> � <br /> Print Name: <br /> Signature: Date: <br /> Dater <br /> Print Name: <br /> Signature: <br /> 11 Print Name: <br /> Signature: Date: <br /> 1'i lil:V:IYI/IIIn1NlI'I.FNAI'I'!111y'1'1.1 NYA1Whl•1'1'b1111 NCV 2/l/99 -^ <br />