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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY RLE AN APPLICATION. j <br /> 1,the Owner/Agent agree,to defend indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or <br /> proceeding agaihst the Owner/Agent's project. <br /> .. i <br /> I further certify,under penalty of perjury,that I am(check one): <br /> (2a Legal properly owner(owner includes partner,trustee,grantor,or corporate officer)of the property(s)involved in this <br /> application,or 'igGUN�I'" <br /> 0° : Legal agent(adach 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 /> Print Nae' Signature: Date <br /> m <br /> Print Name: i 5-' Y of signature: Date: <br /> Print Name: .... . r ;. ,. Signature: bate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> { <br /> { <br /> Y <br /> i <br /> .. ..1►� -.+T®+w:�.. '.wrr.`wn��> r -�r1n.T�--y'+w�rr�+i"�"'i'.-:�.�C ^'4�nrM..i/+.v�eFR� `�nrr'..�irre'e-' .:�y1`. <br /> MINORSUMPP FORM REV. 6-10-01 (IHM - - <br />