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�pmx APPLICATION - MINOR SUBDIVISION <br /> ` s SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> �c�C6R? <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> [,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 OwnedAgent's project. <br /> I further certify, under penalty of perjury,that I am (check one): <br /> UI 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 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 their behalf..and that the foregoing application statements are true and correct. <br /> Print Name: , lit `Q r Qce- /ha I / signature: dte: <br /> Print Name: r ee Signature: d Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name. Signature: Date: <br /> FIDEVSJ3'%P1anrdng.Appf"ton Forms7AfmrSubdmision(Rev 2-1-11) Page 7 of 9 <br />