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°perw �r`° APPLICATION - MINOR SUBDIVISION <br /> y�� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ' 6 %y FILE NO: MS- _ <br /> c . <br /> ��FOP� <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 County arising from 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 owners 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 <br /> statements are true and correct. <br /> Print Name: n r(O r Signature: .�G.l�JQ-•� .moo �/io,C ,Oi Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> HI)EMSVS\Planning Application Forms\Minor Subdivision(Rev.05-11-09) Page 7 of 9 <br />