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�PgJlry.p <br /> a L 2 <br /> kPPLICATION - MINOR SUBDIVISION <br /> ( k SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • I FILE NO: MS- <br /> c�'7<ic'o'dN�F. <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 /> 1 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 We and correct. <br /> Print Name: boigP& o I IaoyP Signature: �/OC-�7yl2el,�Jl. Date: <br /> Print Name: Cl11'� H mo F Signature: l j Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F\DEVSVS\Planning Application Forms\Minor Subdivision(Rev_6-03-04) Page 7 of 9 <br />