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f <br /> -i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AU SIGIVATURS <br /> ONLY THE OWNER OF THE PROPERTY UR AN AEiTHORlZED AGENT MAY FILE A'N APPLICATION. <br /> i,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> I further certify,under 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 /> r7 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: Sgnaturcz <br /> LLXIW-12�Al <br /> ) Date: <br /> Print Name: Signature: <br /> i <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> F:5111DFVSVs1111Planning Application Forms\MMincrSubdivision(Rev. Page 7 of 9 <br /> 12-Q9-04) <br />