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APPLICATION MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> [ik'o-' <br /> AUTHORIZATION"N <br /> ONLY THS ' <br /> Wk RWIH�OERTY 6 'AUTHORIZED 4 �71Ll <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 County arising from 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 /> El 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: 'Jo H$J S 17-LA(a L, A Signature: 1--;?,viln 40 <br /> r4 J Date: -1/// <br /> o <br /> Print Name: GA U E <br /> Si Z L A Signature: AZ��J� Date: 4//4/10 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name Signature: Date: <br /> RTEVSVSkPlanning Application FormsWinor Subdivision(Rev.05.11-09) Page 7 of 9 <br />