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p <br /> �^ x <br /> APPLICATION - MINOR SUBDIVISION <br /> r SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> ' <br /> , TyI GN{`�T RCG +M1 <br /> jn�7 .`4,'i" <br /> ..-.4woPORP1.T,N � vA� Yy NIAY` I JNPr,►ATlQN ;x`x ��,; <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/Agent's project. <br /> I further certify,under penalty of perjury,that l 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 prof 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: C. . /�% k9 ©r Signature: ate: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADE vswianrdN Ap>wC Wn FarmsWinw subdKftlon(rwA249.04) Page 7 of 8 <br /> 1 <br />