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U.!& <br /> APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> AUTHORIZATION SIGNATURES <br /> 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 <br /> employees from any claim, action or proceeding against the County arising from 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) <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 /> i <br /> Print Name: Kv,%yr> Signature: Date: <br /> Print Name: pQmy.h55Q. M,2' )CS Signature: #KLDate: I-095-11 <br /> Print Name: t\b"LD Signature x Date:!'ZS-17 <br /> Print Name: _ IILM GlE,;-pJ L Signature: - of�- Date: I-ZS�I'� <br /> Print Name: Signature: Date:— <br /> - <br /> F WEVSVOPIanning App+ca'Acn Formsi Page 5 of 7 <br /> Lot L'ne Adjustment doc (Revised 05-11-09) <br />