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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> CST AUTHORIZATION SIGNATURES <br /> ONLY THE OWER OF 1Y4Et:90P*RtY0RA(fA0M0R1ZaaAamr*AY:RtsANAePtxATtoN <br /> 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents,officers and employees <br /> from any claim, action or proceeding against the OwnedAgent's project. <br /> 1, further, certify under penalty of perjury that I am(check one): <br /> 0 Legal property owner(owner includes partner, trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owners consent to the application)of the owner of the property(s) <br /> involved in this application and have been authorized to file on their behalf, and that the foregoing <br /> application statements are true and correct to the best of my knowledge and belief L.t <br /> Print Name: Virginia B. Martins Signature: V tiTg B 1 cT� l I`urate: f <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date, <br /> Print Name: Signature: Date: <br />