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'oPA4n,. APPLICATION - MINOR SUBDIVISION <br /> N: <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> c•., a. H`' FILE NO: MS- <br /> " o <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 claim, <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 /> XLegal 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 application of the property's involved in this application and have been <br /> authorized to file on their behalf., and that the foregoing+application statements are true and correct. <br /> Print Name: '�i�N C 1)O ZL 4� 1n b Signature: V <br /> 1Mta Date: <br /> LLPrintName: <br /> Signature: <br /> )� Date: <br /> D Signature: /q <br /> �j� Date: <br /> Ll alL�7 i�— Signature: ff <br /> Date: <br /> Signature: <br /> Date: <br /> F:0EVSVS\Planning Application Fo" Minor Subdivision(Rev.05-11-09) Page 7 of 9 <br />