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0�4Uf� <br /> ' APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> WomX <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees 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): t <br /> ❑ Legal property owner(owner includes partner, trustee, trustor, or corporate officer) of the property(s) <br /> involved in this application, or <br /> ❑ Legal age (attach proof of the owner's consent to application of the property's involved in this <br /> applicat' n nd have been authorized to file on t it b half., and that the foregoing application statements <br /> are tru correct.` ` <br /> Print Name: f't• I`�t Signature: -7/1Date: <br /> Print Name: Signature: Date: A <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: _ <br /> Print Name: Signature: Date: <br /> i <br /> e <br /> 7 <br /> F.1DEV$VC%P1anning Application Fonnsl ' Fuge 5 of <br /> Lot Line Adjustment.doc_(Revised 64-04) <br />