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Ilri - <br /> LOT LINE ADJUSTMENT <br /> SAN DA UIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> to <br /> g de end inch <br /> • f mnffy,and hold harmless the County and fits agenu,a�cers and employees,from any claim,action 1 <br /> or proceeding against the Owner/Agent's project. <br /> 1,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 /> i <br /> I <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 application statements are true and correct <br /> Print Name: p C 1 Signature: , <br /> s �� _Date: <br /> Print Name: Signature: �� <br /> — '�- nate: <br /> Print Name: <br /> Signature; s <br /> Date: i <br /> Print Name: Signature; <br /> Bate: <br /> Print Name: <br /> Signature: <br /> Date: <br /> f <br /> I <br /> I <br /> Ili <br /> ww�•.�'<.. .. - -_- -' _ a.r 'tea � y <br /> j <br /> _q_ <br /> I <br /> ' 1 <br />