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SUMS (MH) <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �.� 1 <br /> c<�s;R'iiS;, <br /> c .rx>wIG <br /> UTHORIZ4TlON'SNATUkES <br /> W gpx .y <br /> F-z I ,`;:; � t1�Y! „'.�. �x' { ': 1' e. i;=}: °�aka'"Yi,;f''' t <br /> �' :> :.' + ONLY,THS.OWNEROFT116:PftOPERTYOR,ANAU,TFfORI-- ENT",MA'YFILEAN'APPLICATION';��, <br /> 1, 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 /> 1,further, certify under penalty of perjury that I am(check one): <br /> ❑ Legal property owner(owner includes partner,trustee, trustor,or corporate officer)of the property(s) <br /> involved in this application,or <br /> ❑ Legal agent(attach proof of the owner's consent to thea application of the property's AP p p rty's Involved in this <br /> application and have been authorized to the on their behalf) <br /> and that the foregoing application statements are true and correct. <br /> Print Name: `- eE 1 Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: �r <br /> I <br /> f <br /> I <br /> I <br /> 1 <br /> i <br /> k <br /> } <br /> h <br /> I <br /> R:25025-MofficelSubmittalsTor Submittal 20061Tentative Map Application Form-Cassano.doc -4- <br />