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-APPLI -A TION. MINOR'S UBDI VISION <br /> " SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AEITNORlZATION S`lQNATURES ` <br /> E <br /> ON[K TME,OWNER OF THE.PROPERTY.OR AN <br /> AUTHQRIZED.AC,EN r MAY FILE AM APP.LI CATION <br /> 14 the ngr/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 protect. <br /> 11 further,'certify under penalty of perjury that l am(check one): <br /> Legal property owner(owner includes partner,trustee,trus <br /> application, or tor,or corporate officer)of the properly(s)involved In this <br /> 0 '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 file on their behalf 'and that the foregoing application statements are trus and correct <br /> Print Name: G , , <br /> Signature: ate: <br /> I Li)o I <br /> Print Name: Signature:- Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name. Slgnaturp: Date: <br /> 44 <br /> k <br /> ` t <br /> - 6 <br /> a <br /> y _ <br />