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APPLICATION - MINQR SUBDIVISION t <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;A .ORtLI taKat�l!4TLIRE;li� ' <br /> c <br /> .....'ren S{....a..... i .. ✓i.. � �-5.{.. <br /> ON4X;7HEOWI�}ERCJF;THE ROPIiTY. NAIf� t <br /> I,the OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,actlon <br /> or proceeding against the OwnerlAgent's project. <br /> I,further, certify under penalty of perjury that I am(check one): <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the propertyls)Involved In <br /> this application,or <br /> © Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to fire on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> S(FL ti :ter J- 27 C3 <br /> Print Name: tL NifCy1 Signature: Date: <br /> Print Name: _ Signature: Date: f_ <br /> Print Name: C�4 h C Li'l e-rSo1l Signatur . Date: -d3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> r <br /> ' I <br /> —5— <br />