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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> "'M <br /> 0 WHORIZAT. <br /> MRS UP IONISIGNATUI39Vh <br /> 0 P..-I-R-1 <br /> 0 <br /> 0 <br /> "Now <br /> T U <br /> ER 0 -A A.P..,CAM <br /> P , 0 AW M <br /> A IL <br /> 1,the Owner/Agerrt agree,to defend,Indemnity,and hold harmless the county and its agents,offIcels and employees from any claim,action <br /> or proceedln <br /> .g against the Owner/Agent's project. <br /> 17� 777eck one): <br /> 1,further, certify under penalty of perjury that I am(ch <br /> Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(3)involved In <br /> this application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> 2,0 F-0 3 <br /> Print Name: 11D GV 1. lgme-fflc�-. Signature: Date: I I — <br /> Print Name: T�f-r Cc INA M e-te, Signature: P , E(J_Ca Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Pr1rit Name: Signature: Date: <br />