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p4ul� APPLICATION - MINOR SUBDIVISION <br /> e: <br /> �: �< SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> (4k. <br /> S- <br /> �'AIik OR�vp <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 County arising from 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.,w�a�nd that the foregoing application statements are true and correct. <br /> Print Name: �.1Qc OU'ELl /. TO� Signature: t Z '� Date: o�/z�///s <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application FoonslMinor Subdivision(Rev.05-11-09) Page 7 of 9 <br />