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V4001 .� <br /> APPLICATION - MINOR SUBDIVISION <br /> ( ; 4 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATU7AP1 <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AY FILE AN APPLICATION. <br /> I,the Owner/Agent agree,to defend, indemnify,and hold harmless the County andofficers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project. <br /> I furt <br /> her certify, under penalty of perjury,that I am(check one): <br /> gal property owner(owner includes partner,trustee, grantor,or corporathe property(s)involved in this <br /> pplication,or <br /> gal agent(attach proof of the owner's consent to the application of the volved in this application and have been <br /> thorized to file on their behalf., and that the foregoing application statee and correct. <br /> : J Oen N S(lA i= LZCj1LI Signature: Da1e: !C-(B-oS: /Jli9/.L�JAll STiq/f/p,D,C/ Signature: Date: //-/�"�'': Signature: Date: <br /> : Signature: Date: <br /> : Signature: Date: <br /> F9nEVSVSIPlanni19 Application Formsftnor Subdivision(Rev.6-03-04) Page 7 of 9 <br />