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° APPLICATION - MINOR SUBDIVISION <br /> r y <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `c FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> [action <br /> the OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> 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,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 an their behalf.,and that the foregoing applicatio statements are true and correct. 7/�� <br /> PdnWa Signature. Date:✓ 17-0 <br /> Print Name: Signature: U Dale: <br /> Print Name: LARrL(,f t J . )h fJYZn II) Signature: Date: <br /> Prinl Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVSWIarming Apll.tlnn Formsw9 .r Sueoivislon(Rev.12-0e e4) Pagel of <br /> VD71121win-doclminor subdvsn_app.pdf <br />