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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •;L� j`r, FILE NO: MS- <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 County arising from 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 /> tName: <br /> lication, or <br /> gal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been <br /> thorized to file on theeir_beehalf.,and that the foregoing application statements are true and correct. <br /> 1 u V / Z v Z Signature: Date:G9 r^ l" UCy .Signature: Date:Signature: Date: <br /> Signature: Date: <br /> : Signature: Date: <br /> FADEVSVSNIanning Application FonnsWinor Subdivision(Rev 2-1-11) Page 7 of 9 <br />