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APPLICATION - MINOR SUBDIVISION <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> T 911liZATION <br /> S-THORIZAT'ION SIGNATURI=$ <br /> :. ONLY THE GINNER OF TME PROPIrRTY�OR AN AUTHORIZEDAGENT�MAY.,FILE ANAPpLICATiON. <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 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 /> r <br /> rrint Name: ! rJGG Signature: 1 Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Dater <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:0EVSVSnann1ng App[kmion FonnslMinor Subdivisbn(Rev.12-0404) Page 7 of 9 <br />