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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 /> 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 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 the property's involved in this application and have been <br /> authorized to file on their behalf., and that the foregoing applicatio tatem is are true and correct. // <br /> Print Name: Dominic S. De Palma Signature: Date:/o U/ 07 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEMS\Planning Application FormsWinor Subdivision(Rev. 12-09-04) Page 5 of 5 2007-134 MS.doc <br />