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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUlN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORlZ4T1ONSI0NATURES ' I <br /> ONLY THE.OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAYFILE 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,action or <br /> proceeding against the Owner/Agent's project <br /> 1,further, certify under penalty of perjury(hat I am(check one): " <br /> Legal property Owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)involved in this <br /> application,or <br /> O Legal agent(attach proof of the owner's consent to the application of the property's Involved in this application and <br /> have been authorized to Nle on their behalf.,and that the foregoing application statements are true and correct. <br /> j4Print Name: ��—�t G �1 , �QI'oSignature: f1i ate: I q lo <br /> Print Name: 1 i Lu W\G"-S L�L Signature: Dafe: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Dale: <br /> _§_ <br />