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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY,DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> y <br /> AUT�o�rz�T�aN toN� <br /> s rul�I=s <br /> Tk1[EWNR UFTHI=PRC)PER`lY t71aAN AUTHORI' R AEMT= YiI�Y f�L 34N ARPLIGATIQN <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees=- ify, yeas from any claim, <br /> action or.proceeding against the County arising from the Owner/ is project. <br /> p 9 9 tY 9 Owner/Agents <br /> I further certify,under pens of perjury,that I am(check one): <br /> nY <br /> [] Legal property owner(owner incudes 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 propertys involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoing application statements are hue and correct. <br /> Print Name:��,�n RGG P � IHS Signature: - // Date: <br /> Print Name: ' �� V� Signature: `'"�7 --_ Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> s <br /> I+` FADEVSMManning Application FormskfAnor Subdivision(Rev.05-11-09) Page 7 of 9 <br />