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APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,the OwneNAgent agree, to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am(check one): <br /> o Legal property owner(owner includes partner, trustee, trustor,or corporate officer)of the property(s)involved in <br /> this application, or <br /> o Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> �have been authorized to rile on their behalf.,and that the foregoing application statements are true and correct, <br /> /` <br /> Print Name: &Lil �T�-Fn 7 Signature: Date: <br /> I A— <br /> L i� '� �'� Date: <br /> Print Name: l/.�JV'C, U�1 Signature: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> n D[VesV xUY[/rx.�b{/YAd�O�prvArr) INSO/]Uol i101 <br /> -5- <br />