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0APPLICATION - MINOR SUBDIVISION <br /> " ` SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION <br /> AUTHORIZZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR ED 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, <br /> action or proceeding against the Owner/Agent's project. <br /> 1 further certify, under penalty of peoury,that I am (check one): <br /> ® Legal property owner(owner includes partner, trustee, grantor,or corporate officer)of the property(s)involved in 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 /> Randy C.and Arlene Sasaki Roget <br /> Print Name: Randy C.Ronet Signature: QI Date:n 0)i <br /> Print Name: Arlene Sasaki Rouet Signature: Date: Oq O I AL')7 <br /> PrintName: RCL E( Signature: Date: `I ( 2L-n <br /> Print Name: IaRILNE5A5AKl P�Yal'I Signature: Date: <br /> F:MFVSVS"anning Application Fomns\Minor Subdivision(Rev.12-09-04) Page 5 of 5 2017-125 Minor Subdivision <br />