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APPLICATION - MINOR 'SUBDIVISION <br /> y: SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> F. PILE NO: MS- <br /> 6.r_ <br /> T 0 <br /> R. <br /> S- <br /> OR.ZATIC�N SIGNATURES <br /> ONLY tHE QWNER 01= SHE PROPERTY O 'kAN AU1 HOIt11=Q NsEN, xMAY FILE AN APPLICATIt7hN <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): <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 propert ' involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoing application state nt ret rr <br /> Print Name: e"O' & r Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVS1Planning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />