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,%W,. <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> A <br /> a• <br /> y <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOP MENT DEPARTMENT - <br /> {c FILE NUMBER: <br /> AUTHORIZATION E <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 an <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 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 statement <br /> are true and correct. <br /> n .. / <br /> Print Name: �L(ViJ At V1/ ! I II Aa hi3Signature: I - - Date: 7— S�GT/ <br /> Kca FAL (2e„ W '1 I i a in tj g <br /> ----- <br /> Print Name: AA r Signature: Date: 7- <br /> Print Name: <br /> "PrintName: 7y5 (Jrd rt- co S 'E'r^ Signature: LITDate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\\DEMCUlanning Application Forms\\ Page 5 of 7 <br /> Lot Line Adjusvnencdoc.(Revised 6-4-04) <br />