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a <br /> 7�pRrO APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> L1fibR <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 /> action or proceeding against the Owner/Agent's project. <br /> 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. <br /> E <br /> Print Name: PHILIP N.HENRY.TRUSTEE Signature: / / t E Date: .3—U <br /> Print Name: JERROLDR. HENRY.TRUSTEE Signature: ���� Date: 3�Z Z <br /> Print Name: HELENA R.J.M.SCHREURS-HENRY Signatu Date: <br /> Print Name; Signature: Date: <br /> Print Name: Signature: Date: <br /> k <br /> RIDEVSMPIanning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />