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APPLICATION—MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> A�v1 T RE5 <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILEAN APPLICATION. <br /> 1, the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents,officers and <br /> employees from any claim,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, trustor, or corporate officer)of the property(s) <br /> J nvolved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf),and that the foregoing application statements are true <br /> and correct <br /> Pint Name: V,2 JW,,- JCc X, g <br /> Print Na �— / T SigL t— Date:Pnnt Name:yJO Ran P,12Ok SgDate: <br /> Pnnt Name: CL6rn Gf)T L6W tg HOIiT Sig Date: 8-9-03 <br /> Print Name: Signature: Date: <br /> P Luhmp 122067034Lxs'rppliatiomi.4ppMinocSubdivixm.rL><: <br />