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„. <br /> APPLICATION - MINER SUBDIVISION <br /> � SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> / <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 /> 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. <br /> Print Name: 7-r✓S4CG Signature: I& wvl'4— Date: :X 0 0(0 <br /> Print Name: rhe, e_5c, lYl. .✓ASS Tl✓S c Signature: Date: <br /> Print Name: -:�;teveoq 17)e-GK4*S5cL Signature: -, Date: <br /> Print Name: Signature: Date42 0(. <br /> Signature: <br /> Print NaL L� l L <br /> me:L'1�i�SM��e 4-116"4414-116"441Z✓lik- Date: <br /> FADEVSVSTIanning Application Forms\Minor Subdivision(Rev. 12-09-04) Page 7 of 9 <br />