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Qu! APPLICATION - LOT LINE ADJUSTMENT <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NUMBER: <br /> �t- <br /> M li' lu <br /> OIKY—T lE GWS ER DF; 'i E:PROPER Y.ORIAKAUMMIZED AGENT 11 MAY.FlLE AN APPUCA110K:., <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): <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 /> c;c, cr., r, <br /> Print Name: �_ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:GEVSVCUPIanningApplication FortnsX Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 64-04) <br />