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°P44IlY.- APPLICATION - MINOR SUBDIVISION <br /> c SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> �P <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: Signature: Date: <br /> Print Name: 124, Tt 0-41 . n Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: k/r//r 9 419;?-h yj Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application Fonns\Mina Subdivision(Rev.12-09-04) Page 7 of 9 <br />