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., aga4'.liY, y i <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> w SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> 4 <br /> fi AUTHO�IZgT�lO'N.�SI��IVATI�R�S _ � wf > -, <br /> fONLY�THE;:OV1iK�R OF.TkIE�,PRO�ERTY OR JsN=.,tfT�lQ� � � ��� <br /> M�4't�'�fILE�iANi4�?PI�ICATIOfiIs p,' <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 /> 1, fu her, 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) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property' <br /> are true and correct. s involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> 'Print Name:'S .— L ghQL el <br /> Print Name: <br /> Signature: Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name:. Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: I <br /> k <br /> Ik� <br /> 1 <br /> t <br /> f <br /> 4 <br /> F:1)EI/SVC{1anning Application Formsl Page 5 of 7 <br /> Lot Line AdjustmenUm(Revised 8-4-04) <br /> i <br />