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APPLICATION - MINOR SUBDIVISION <br /> q. . �: <br /> �w,; SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTtiIENT <br /> FILE NO: NIS---------------- <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 /> j action or proceeding against the OwnerlAgent's project. <br /> i <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. 1tt� <br /> Print Name: Signature: �� Date: ICK-o� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F NOEVSVS%PIannmg Application Forms\Minor Subdivision(Rev,6-0304) Page 7 of 9 <br />