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i <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> ����irRY.I�Ffi L �1fL1Af��0,'!R'f'S)�.�,v�l�i�1.,�.(+'l��,a.?.!:t`�P�ff �li :�'N�.,`s�J�e}.r�.-ak�.,v��r��.f'k�1,i,d • <br /> I,the Owner/Agent agree,to defend,Indernri fy,and hold harmless the County and Its agents,officers and employees from any cialm, <br /> 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, grantor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the appllcatlo the property's involved in this application and have been <br /> autho to file on their behalf.,and that the foregoing appllc� ons menta are and correct <br /> . <br /> Print Name, '55,1 Signatur Date:, <br /> Print Name: Ic Signatu. 4 - Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F' VSVSVnwr,✓np AppWatkon ForrnAWWSLOdkviaiw(Rev,12-09-D ) Page 7 of 9 <br /> l <br />