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ti w .e <br /> APPLICATION - MINOR SUBDIVISION <br /> • .off <br /> a `yam <br /> h :< SAN JOAQUlN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> G+• �P <br /> C11=U•� <br /> i <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <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 orroceedin against the County arising from the Owner/Agent's project. <br /> P 9 g <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 /> ❑ 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. l Signatur Date <br /> Print Name: Signat Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 4 <br /> I <br /> i <br /> FADEVSMPlanning Application FormsWinor Subdivision(Rev.05-11-09) Page 7 of 9 <br />