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,,r <br /> °mac 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 /> I,the OwnerlAgent 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., and that the foregoing application statements are true and correct. <br /> Print Name: Signature: Date: <br /> i Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> **John Fugazi Peter Bulthus John Lewis <br /> PO Box 509 280 Sun Valley Ct. 1628 Daniels Road <br /> Linden, CA 95236 Ripon, CA 95366 Escalon, CA 95320 <br /> (209)470-7699 (209)481-9193 (209)607 0642 <br /> POEVSVSIPianning Application FormsWlinor Subdivision(Rev.05-11-09) Page 7 of 9 <br />