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°4ylt,- APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ...Qk'� FILE NO: MS- <br /> rF---R� <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/Agents 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 statement's are(true and correct. <br /> PrintName: �AI.V Io,Qp+A.�, TIZOSTC(c Signature: , , nate: (V It.( to> <br /> T2JST ,�.tD�wr <br /> Print Name: Signature: <br /> Print Name: Signature: d Date: ,, / <br /> Print Name: G�S /P�M�� Signature: �-`�� �-o Date: 6_/_?:c/1, <br /> Print Name: Signature: Date: / <br /> F:OEvsvSW%rNrp Argkaaon Fam9WA SWAMa (Rev_6-0304) Page 7 of 9 <br />