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' r i <br /> AQUiN APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •' '• FILE NO: MS- <br /> �<<FORa <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., and that the foregoing a cation statements are4rue and correct. <br /> Print Name: f10 �� Vd�� Ce.r\ 11 Signature:f 1/ Date: <br /> Print Name: e 0-t1 C cct�r )Agc.n SignatureC' S <br /> Date: <br /> Print Name: JC h o Va.it d«11r r1ye nSignature: Date: <br /> �Print Name: ho-V 1toy6�-41 l o t1�11GC c1 Signature: / Date: <br /> e: �f-Lat Vail C_ rdf1(/1Jf± Signature: Date: <br /> 1 <br /> ->cSl�e wIe�tt.STi"c� � <br /> Ja,S c t1 W-11 rC#1 i�{ ►� /at <br /> a-rt VCc-!1 �(or1c/1 it <br /> F:\DEVSVS\Planning Application Forms\Minor Subdivision(Rev 2-1-11) Page 7 of 9 <br />