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°p4ui" APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Vi: C <br /> FILE NO: MS- <br /> C4„ <br /> .F ptetN <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 /> ❑ 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:Annamarie Gwerder Signature: Date: <br /> Michael S.Glazzy and Cathleen S.Glazzy,Co-Trustees of the Michael S. azzy and Cat en S. Glazzy Family Trust Dated <br /> June 1,2006 -/ <br /> Print Name: Michael S. Glazzv,Co-Trustee Signature: Date: t <br /> Print Name: Cathleen S.Glazzy,Co-Trustee Signature: Date: T l� <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application Forms\Minor Subdivision(Rev.12-09-04) Page 5 of 5 2016-117 Minor Subdivision <br />