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v <br /> orRau�>r. APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •.SRC) :, <br /> FILE NO: <br /> l <br /> MS- <br /> TIQNSIGNATUAUTHORZA <br /> RES , <br /> ,'��` a ::O�1L,Y THE OW[1fER OF-THE pRaPERTY OR;AN Al1THORIZED AGENT=1Vl�►�F#I•.E���# APPS.PATI 2T1 -�,r��: <br /> y 1,the OvunerlAgent agree,to defend,irrdemn�fy,and.hold harmless a County and,jts agents,officers and employees from;any claim <br /> f action or proceeding against the OwnerlAgent'8 project <br /> further certi€y,under penalty of perjury,that t am.(check ane) <br /> `:V�3 Legal property owner(owner includes partier,Arustee,grantor,'or corporate of#icer)'of the property(s):involved iii 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 /> i <br /> Print Name: _/y/r, i C7ll Signature'z' .t•!.� Date: 0 7 <br /> � �' 7 <br /> Print Name: {1 � /l9 /2y! Signature: ' Date: <br /> { <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 1 <br /> i <br /> 'r <br /> f <br /> i <br /> f <br /> FADEVSVS1Pianning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />