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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the OwnedAgent 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 OwnerlAgent's project. <br /> I further certify, under penalty of perjury,that I am(check one): <br /> ,Q 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 beer.. <br /> authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> i <br /> I -_ <br /> Print Name: wKf21ANE fA2tA Signature: _ZQLA;"e: 'DEC-.0-7012 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RIDEVSVSIPIaming Application Fo VA=r Subainaion'(Rev.05-11-09) Page 7 of,9 <br />