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o- <br /> APPLICATION -- LOT LINE ADJUSTMENT <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t••Q FILE NUMBER: <br /> _ R <br /> i <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 /> I,further, certify under penalty of pequry that I am (check one): <br /> Q 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 pro y's involved in this <br /> application and have been authorized to file on their behalf., and that the f g ng application statements <br /> are true and correct. <br /> Print Name: L A C, , Signature: - Date: `C.Y—/ •�('�� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date; <br /> Print Name: Signature: Date: <br /> FADEVSVOPtanning Application Formsl Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 64-04) <br />