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LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :aAY1TNQRIZ�L�.,tSlGNA777IR <br /> �4 ��,� � <br />� � ., i�Q�VtY` i; .s'4Wfil n l;y+�Fi1PRb1?LLIt r�i:tRA'..eA QRlYE�],�/tGk7VTMs.I�'IL�AN,A _tIZ�.4��'samia m. ;m`���r'.Nc.:.•'��t5`w�'?; <br /> 11 the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees,from any claim,action <br /> or proceeding against the Ov►ner/Agent's project- <br /> 1, <br /> roject1,further,certify under penalty of perjury that 1 am(check one): <br /> X Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have <br /> been authorized to file on their behalf.,and that the foregoing applica n statements are true and correct <br /> r <br /> Print Name: `�+1 L l J? — Signa Date: {, 03 <br /> Print Name: J A/J ) [ ,C Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date- <br /> Print Name: Signature: Date: <br /> I <br /> f <br />{t <br /> I <br /> iI <br /> .q. <br />