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PPLICATION - MINOR SUBDIVISION <br /> m: .Z_A SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> 9GiFORA <br /> L A a ti: wk ave s: e E3;2T <br /> I, the Owner/Agent agree,to defend,indemnity,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 state nts are true and correct. <br /> Print Name: Alf fly NQOSV Signature: Date: /Q <br /> Print Name: Do res L l m Signature: Date: j2//U .2wq <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVS\Planning Applip ion FonnsWinor Subdivision(Rev.1-2-03) Page 7 of 9 <br />