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pp4��N FILE NO: MS- <br /> APPLICATION - MINOR SUBDIVISION <br /> ¢ z SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> '` <br /> p <br /> qG%Fp•� <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 /> application,or <br /> Legal agent(attach proof of the owners 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 /> M <br /> Y � .� j� r1 <br /> Print Name: do/A /"I c) is Signature: �' &—n / J L& Date: <br /> Date: <br /> f <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F OEVSMPlanning Application FornnsW4inor Subdivision(Rev 2-1-11) Page 7 of 9 <br />