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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> w'I ya <br /> -- AUTHORZI7ION SIGNgTURES � <br /> ONLY THE OWNER OF THE PROPERTYORAN AUTHORIZED AGENT MAYFILEAN APPLICATION. <br /> i, the OwnerlAgent agree, to defend,indemnify,and hold harmieu the County and Its agents,officers and employees from any claim,action or <br /> Proceeding against the OWnerlAgent's project <br /> !, further, certify under penalty of perjury that I am(check one): <br /> lk Legal property owner(owner Includes partner,trustee,trUStOr,or corporate officer)of the property(s)involved In this <br /> application, or <br /> 0 Legal agent(attach proof of the owner's consent to the application or the property's Involved In this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> PrintName; LzlAA1-1-A/ )tel/.-/ i ( ( Signature Date:�1 —")Z <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature., Date: <br /> -s. <br />