Laserfiche WebLink
I <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 Owner/Agent's project. <br />I, further, certify under penalty of perjury that I am (check one): <br />[Z] 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: CHASITY CHANDLER <br />Print Name: <br />Print Name: <br />Print Name: <br />Print Name: <br />F:\DEVSVC\Planning Application Forms\ <br />Lot Line Adjustment.doc. (Revised 6-4-04) <br />Signature: <br />Signature: <br />Signature: <br />Signature: <br />Signature: <br />IJf�a� Date: .� -l_<t,-2\ <br />Date: <br />Date: <br />Date: <br />Date: <br />Page 5 of 7 <br />I