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v <br /> �+T <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Auri+oliizaFianrsIGNAiLlRrz: . . <br /> ONLY THEOV4NFiZ dF TIE:RROPER7Y OfrAM`AflTfiORtZED AGENT Mf4Y.Ffi,E g14'pPPLICATiOIY = <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am(check one): <br /> qX Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)involved In <br /> this application,or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: 1 i cC - - 1) Signature:(J {Y(,� Signature: 7� -�tG" � � Date: Z <br /> 1 W 9 <br /> Print Name: Signature: Date, <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> J <br /> -4- <br />