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APPLICATION - LOT LINE AD <br /> JUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .'`�'' P • FILE NUMBER. <br /> R<<FOR \ <br /> AUTHORIZATION SIGNATURES <br /> r 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 employees <br /> from any claim, action or 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 /> ❑ Legal agent (attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf., and that the foregoing applicationts.are true and correct. <br /> Print Name: �S f /401' Signature: Date: 41 9,'o 9 <br /> Print Name: 7l2-'J►� L!/ � �' Signet e. } Date: Q <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature, Date: <br /> I <br /> i <br /> I <br />