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P.�tN FILE NO: MS- <br /> APPLICATION - MINOR SUBDIVISION <br /> a. Tcr SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t <br /> -•C)F OF�� <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 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 /> Print Name: ERIC SORENSEN Signature: <br /> nn Date: <br /> Print Name: DONALD SORENSEN Signature: Date: 5/-Z7//-3 <br /> Print Name: KIMBERLY TEMPELTON Signature: Date:5-Z I ! 3 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F.IDEVSVSPlanning Applic Wn FonnsWlinor Subdivision(Rev_12-09-04) Page 7 of 9 <br />