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4W1 APPLICATION - MINOR SUBDIVISION <br /> Ze SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> CI••. (P <br /> GlPGR� <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 claim, <br /> action or proceeding against the County arising from the Owner/Agent's project. <br /> [Print <br /> 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. �7 <br /> e: /7 �/ < � Signature: I Date: <br /> e: Signature: Date: <br /> e: Signature: Date: <br /> e: Signature: Date: <br /> e: Signature: Date: <br /> F:\DEMS\Planning Application Forms\Minor Subdivision(Rev.05-11-09) Page 7 of 9 <br />