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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 /> 1, 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/Agenrs 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 properly(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 applicalio Statements are true and correct. <br /> Print Na Signature. / Date: _O <br /> Print Name: T Signature: Date: <br /> Print Name: L4kztL(4 l / 6Nf)gAjj Signature: Dale: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:1e EVSVS%PWMnq Appllmdon FormsWlinsr Subdwisim(Rev 12-0904) Page o19 <br /> t107112Wvfn-docMinor subdvsn_app.pdf <br />