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is ! <br /> 4 <br /> a¢quIH. <br /> _ APPLICATION -- LOT LINE ADJUSTMENT <br /> L Clot _G <br /> r. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> C/FQ� <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 Owner/Agent's project. <br /> I <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 statements <br /> are true and correct. <br /> Print Name: /rq Z.2 4 `r -q Signature: RDate: <br /> Print Name: Signature: Date: i <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: i <br /> s <br /> I <br /> r <br /> i <br /> I <br /> 3 <br /> jI <br /> I <br /> I <br /> i <br /> Ii <br /> 1 <br /> 1 <br /> 's <br /> f <br /> FADEVSMPlanning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 6-4-04) <br />