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�I <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1,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 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: 1th�77gbaJl 13JUrhesoN Signature: PJAZ'a N'Ia_veil Dately)a- lb ZD 3 <br /> CU) � <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F9DEVSVSPlanning Application FormsWinor Subdivision(Rev.0541-09) Page 7 of 9 <br />