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0T LINE ADJUSTMENT <br /> SAN JOAQu1N COUNTY t vuNITY DEVELOPMENT DEPARTMENT <br /> At1TNbR14770N BIGNA3 i1RES,. <br /> CUNLY..7N OWN ROF7f7 PROPERTYoi?INA[t7FfClFt�IEU�IGEN7INU1Y. lLEAN ,4�PLfGAT7bN <br /> 1,the Owner/Agent agree,to defwd,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> 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)involved In this <br /> application,or <br /> O 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 application statements are true and correct <br /> Print Name: sV C/ n n, r, Signature: Date: C`!(-tl <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature; Date; <br /> P <br /> WON <br /> FF WNW <br /> 10:03 AMPA_LAQA Fob—q 1.1589 <br /> —4— <br /> E <br />