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�4u ti APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> `R OR'N <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> i <br /> I. 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 /> I further certify, under penalty of perjury,that I am (check one). i <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 /> Print Name: Dr. Gurinder Singh Grewal Signature:S " � Q"� Date: / 2-11-4o-Y <br /> Print Name: Gurmail Kour Grewal Signature: Pti, =� IG S/_ -< 1;� _I Date i 't 24'2— <br /> Print <br /> 4/2— <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> P.nEVSVS\Planning Application FonnsWinor Subdivision(Rev.12-09-04) Page 5 of 5 2009-155 Mirror Subdivislon.doe <br />