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E _ A-i-PLICATION - LOT L1NtkWUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> I� <br /> O 5 <br /> ONlYTHE OWNER O1F 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 /> s <br /> j I, further, certify under penalty of perjury that I am (check one): <br /> i I ❑ Legal property owner(owner includes partner,trustee,trustor,or corporate officer) of the property(s) <br /> ii 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 /> it application and have been authorized to file on their behalf., and that the foregoing application statement <br /> are true and correct. <br /> Print Name: John H.Merrill Signature: Date: jr C� <br /> rr <br /> Print Name: Christopher J.Merrill Signature. Date: <br /> Print Name: Signature: Date <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> �k <br /> i <br /> i <br /> ii <br /> .P <br /> EI <br /> I E <br /> � I <br /> �h <br /> i� <br /> ( <br /> i <br /> fI <br /> ' i <br /> } i F11DEVSVCPlanningApplication Formsll Page 5 of 7 <br /> Lot Line Adjustment.doc.{Revised 6-4-04} <br /> r <br /> i�l <br />