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T LINE ADJUSTMENT <br /> f SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> F AUTHORIZATION stGNATURES <br /> ONLY THE OWNER OF THE PROPERTYOR AN AUTHORIZED AGENT UAY FILE AN APPLICATION. <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and empioyees from any claim,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> O 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 owners 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: L� ;�f c,Ek j�, L f� , ,� G to r� Signature: � � Date: C'_ 4 2~0 J <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> I <br /> i <br /> i <br /> I <br /> 1 <br /> i <br /> IM. AMPA LA26 F bnmry Y,19W <br /> I <br />