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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> MATURE, <br /> ,tom <br /> :}ON I�THE OWNER G1F THE PRdF�EaTX OR „prUTHORIZED VENTf AY- ,I�E;AN'�APPLICATION <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> Employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> ® Legal property owners (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 owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf, and that the foregoing application statements <br /> are true and correct. <br /> Print Name: ni Signature: Date: Z' 2-3—0 � <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> I <br /> F;IDFVSVC\PIanning Application FormsWinor Subdivision(Rev. 6-03-04) Page 7 of 9 <br />