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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUfN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> yy <br /> ¢''tEx, ,d u•�.+SW,+• ✓yr: r; gi? 52'�.k% !''°kdrti3'R. fYii:;ar'r.;•rh <br /> ``• .. �1't+tr. UTHORIZIF'fIpN-SIflNATL1RES..t °�''_�sK „� ,� <br /> u ai. 3 n> r•y. xs: a'r , �'¢i .i ig� <br /> ": '�' "' +� •Sblv'�` tr>r.OwN��i��� <br /> . .. .. E: f#OPER�OR`Af!'�tJ�iOR�Ci��T�GA' .' AP..'C`AT10fY.:. r•�� ,.. i� �W <br /> I,the Owner/Agent agree,to defend,Indemnity,and hold harmless the County and Its agents,oMcefs and employees from any claim,action <br /> or proceedfn.g against the OwnerlAgent'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 <br /> this application,or <br /> El Legal agent(attach proof of the owner's consent to the application of the property's Involved In this appilcatlon <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: Signature: f <br /> Date: -- aezf-o <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> I <br /> i <br /> -4— <br />