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C) <br />APPLICATION - MINOR SUBDIVISION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />FILE NO: MS- <br />N <br />T, <br />i ZAMS6 <br />laft§N"WOO <br />APPL1CATiQN 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 />El Legal agent (attach proof of the owners 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 />vj, <br />Print Name: *MC::-S,f , Signature: 1 Date: ki <br />Print Name: Signature; Date, <br />Print Name: Signature: Date: <br />Print Name: Signature: Date: <br />Print <br />nt Name: Signature: Date: <br />F:\QEVSVSNPlanning Application FumsUnor SubdivIsion (Rev. 05-11.09) Page 7 of 9 <br />