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Uth <br /> APPLICATION - MINOR SUBDIVISION <br /> r—� SAN JOAOUSN COUNT.'COMMUNITY rJE <br /> FILE NO: 1iELflPA4ENT DEPAR ksENT <br /> MS- <br /> AUTHORIZATION <br /> 1 <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION_ <br /> t.the OwnerfAgent agree.to defend.indemnify,and holes harmless the County and is agents,a5cers and ernployees iron any c>-wm. <br /> action or proomdrig against;:+e OwneeAgenrs prover». <br /> I'urL9er certify,under penalty of pea rayw zha:I am(chc- 4:one). <br /> LeWt 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 Lite on their behalf„and that the foregoing application statements are true and rmrrecL <br /> Print <br /> Date: ,O15 <br /> Print Marne: Signattue: Date: <br /> Print Name: Signature: Da'c: <br /> Print Name: Signature: Date: <br /> Print Name: _ Signature: Date: <br /> {'tpEV$`.'SPlami.n�F4gtcation FwmsWmoresUCCiVI^ulHll tfiow.12-0902) Page 7of9 <br />