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wi <br /> 5 <br /> APPLICATION:' MINOR.t,SUBDIVISION <br /> SAN JOAQUIN COUNTY GOMM0—TY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF TNF PROPERTY OR AN A UT80RIZED AGENT MAY FILE AN APPLICATION, <br /> 1, the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that l am(check one): <br /> Legal property owner(owner includes partner,trustee,trustor,or corporate officer).of the property(s)Involved in this <br /> application,or <br /> O Legal agent(attach proof of the owners consent to the application of the property's Involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: Signature: Date: ~�� <br /> Print Name: e Signature: Date: / 03 <br /> _ <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> s <br /> 1 <br /> . i <br /> _g. 1 <br />