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:fit: "APPLICATION - MINOR SUBDIVISION <br /> "I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTME\- <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any ciaim. <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 beer <br /> authorized to file on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: Signa <br /> ture: \� / ` ✓ ' <br /> _�� Date: <br /> Print Name: Signature, �"�" <br /> a <br /> Print Name: i� F/'T ✓ f7%L/�E. Signature: '—"` Vit' G '^s "— Date:-�--pec- '- <br /> Print Name: <br /> Signature: �r%u��P4 yt., 8 ldt`,@) Date: <br /> Print Name: Signature: Date: <br /> F\DEVSVS1Planning Application Forms\Minor Subdivision(Rev. 12-09-04) Page 5 of 5 2007-205 MS.dcc <br />