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>4=F` A APPLICATION - LOT LINE ADJUSTMENT <br /> F� z <br /> << SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> \:r,. .. .. �i;y FILE NUMBER: <br /> tFOA/ <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 County arising from 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 Qf the property's involved in this <br /> application and have been authorized to file o4behalf., that t e foregoing application statements <br /> are true and correct. <br /> Print Name. SignaturDate: �� Z/ / 'fUPrint Name: Signatur Date: �/ Z1 <br /> Print Name: �Ik 1 SignatuDate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.OEVS=Plann,ng Appkc tm Forma Page 5 of 7 <br /> LM Lme Adjustment. o..(Remsed 05-11-D9) <br />