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�ka�= APPLICATION — LOT LINE ADJUSTMENT <br /> :< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �` • FILL; NUMBER: <br /> •pyo �" <br /> 7 <br /> � _ r a, RUTH 4 R� AOISIGATURH . gid <br /> s: iF <br /> � <br /> � <�.u?'.�: W ;-I Rn,l,iv <br /> `t7NLY THE, �IIiNER OF THE,P,ROP 'IOR ►N AUtl = E ORIZEDANT i<IfIAY IFJLE4. V APpLIGATION a , <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, 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's involved in this <br /> application and have been authorized to file on their behalf., and that the foregoing application statements <br /> are true and correct. <br /> Print Name: Sign Date: <br /> ifri�tt Name: c7 O 5 <br /> _ Signa`ture Date: <br /> Print iVafie: kSignature;,'s DIV <br /> Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> { <br /> i <br /> I <br /> i <br /> I <br /> FADEVSVC1Planning Appiicauon Forms% Page 5 of 7 <br /> Lot Line Adjustment.doc.(Re%lsed&4.04) <br /> 4 <br />