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APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �%FOXN` <br /> FILE NO: <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 /> 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 on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: V �� C-a Signature: 'r Dater ' <br /> Pdnt Name: 11V L/i CQ S Sign ure: '/ Date:/-2 D( <br /> Print Name: Sig ature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> ROEVSVMPlanning Application FO"SVAAJOR SUBDIVISION(Rev.12-09-04) Page 7 of 9 <br />