Laserfiche WebLink
°P APPLICATION - LOT LINE ADJUSTMENT <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • �q��FoRa�P• 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 /> 0 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:/� ,LI,A)b/y *,6ce`T / Signature: ` �d• �� Date: <br /> Print Name:`-Qh]/1��0 ZPUPnl�i Signature: Date: u-a3'a� Ig <br /> Print Name: I hC0 o,PC, :'V Ei J I/V- L <br /> /y/ Signature: ;/tel A �� Date: 3 <br /> Print Name:'�J 6 Signatures` '" J Date:s- 07� <br /> Print Name: 11eA\ e- °`�C�� Signattlrr: �e-"--��"`` v> Date: L:;? a/�S <br /> F:\DEVSVC\Planning Application Forms\ Page 5 of 7 <br /> Lot Line Adjustment.doc.(Revised 05-11-09) <br />