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yF1_.' � APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY_COMMUNITY DEVELOPMENT DEPARTMENT <br /> �N. . ; FILE NO: MS- <br /> 0'4P <br /> 4r�or'� <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 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 /> XLegal 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 the4;,hghalf., and that the foregoing application statements are true and correct. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> s J <br /> 1 Y. <br /> 3 W -- <br /> �r � �` <br /> x .. <br /> 4 " ` P <br /> ; Pa e 7 of 9 <br /> € E 6EvsyslPlanning Applic2 ion °rmslMsnor Sub vision(Rei 12-09 04)x` u g <br /> :..-d .•� - „�, � ,.c«.� Vis. ��� r^ ;. <br /> J '�y <br />