Laserfiche WebLink
R , <br />ff, <br />kj Q <br />gUfl. <br />C APPLICATION - LOT LINE ADJUSTMENT <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NUMBER: <br />fir,,=rnpvS2s+k"-+ d _ ' V " .Tv ` ti s\ <br />Ai7h- <br />y, 'wl .'-q ,i r,g `a; <br />ia ;Si s. Q <br />Et'"i4.`31? ` <br />s <br />Y '`a <br />1:4,g?',;.t 9 `z' '-gY p. + '..'+ <br />Y,,'c.p: "`w t ts, <br />s .'.l F a n.;: r 4. 2::•;„-. <br />bNLY Ti iE(3'U17NE1(F HE P,, t pERT'Alf.,l`i'##O,E:.IG N,M'Y'IL:AN,APRL CA (i N <br />tsrd- <br />1, 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)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 statementsaretrueandcorrect. <br />Print Name: P= Signature:Date: <br />Print Name: Signature: 4,- <br />Date: <br />Print Name: Signature:Date: <br />Print Name: Signature:Date: <br />Print Name: Signature.pate: <br />k <br />I <br />Ei <br />k <br />i <br />Ei <br />E <br />1 <br />U <br />i <br />E <br />Ei <br />VF:{DEVS1lCLPtennirkg AppllCation Formsl Page 5 of 7 <br />tot tine Adjtistmentdoc.(Revised 6.4-04) O<D <br />I <br />f <br />i