Laserfiche WebLink
r�aP4��cyi APPLICATION - MINOR SUBDIVISION <br /> < SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> OqG%FORa`P <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 employees from any claIlk <br /> 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,grantor, or corporate officer)of the property(s)involval iii is <br /> application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application a d 6ave;tieen <br /> authorized to file on their behalf., and that the foregoing application statemenQtsarareettrue/and correct. <br /> Print Name: a4f L, 0 Signature: &9 " 4A _— Date:�ji �Z�- I00 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date. <br /> F:0EVSVS1PIanning Application Fonswinar Subdivision(Rev 2-1-11) Page 7 of 9 <br />