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APPLICATION - MINOR SUBDIVISION <br /> s - SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: NIS-__---------------- <br /> AUTHORIZATION <br /> ---____ _AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICIthis <br /> I,the Owner/Agent agree,to defend, indemnity, and hold harmless the County and its agents,officers and employees <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 <br /> application, or <br /> ❑ Legal agent(attach proof of the owners 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: Signature: �� \ �L(l Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:WEVSVSPIanning Application Fonnslwlnor Subdivision(Rev.6.03.04) Page 7 of 9 <br />