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P0.u`N APPLICATION MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> .: FILE NO; MS- <br /> UT ZATI <br /> 6W <br /> S- <br /> IJTHORlZATION SIGTURES 3;. <br /> frr . <br /> ; - <br /> -j .ONLY THE OWNER OF THE PRK7AN7A7U1"HORIIZED AGENT MAY..FILE"AN`-`APPLICATION <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 Owner/Agent's project. <br /> 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: Steven F. San uinetti Signature. ate:���C?Q-e�Olb'j <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEVSVSIPlanning Application FormsWinor Subdivision(Rev. 12-09-04) Page 7 of 9 <br /> > <br />