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` c . APPLICATION — MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> FONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. I <br /> , gent 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 /> I further certify,ander penalty of perjury,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 owners consent to the application of the property's involved in this application and have been <br /> authorized to <br /> file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: <br /> Signature: date: <br /> Print dame: li -B N e Signature: Date: 766.7_ D7 <br /> Print Name: <br /> Signature: Date: <br /> 'aIv <br /> 7-- <br /> 17plv <br /> i�ac� , C F1 <br /> C F:►DEvsys+Planrpr+g App[MaNnn FormslAAinar Sut3dlvaslnn(Rev.12-09-04) Page 7 of 9 <br /> 4 <br /> i <br />