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a��FOFT*� <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 be n authorized to file on th it be alf., and that tpe foregoing application statements <br />are tr nd correct. C <br />Print Name:1 �� Signature: t Date: 6 <br />Print Name: A Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />F:\DEVSVC\Planning Application Forms\ Page 5 of 7 <br />Lot Line Adjustment.doc. (Revised 05-11-09) <br />