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¢" .P APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> :. ; <br /> 4 W <br /> {' '�reZ�,tf�'A1, 7,HG ,.ATION,SIGNA�Tu <br /> �-FTTO Fi W ERMAN'M'TNQRI=U S} : ;IlfAY'Fl 'A APPLICAT1pN <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: /�' /��T` ��. Signature: Date: <br /> Print Name: l7 Signature: Date: ����• U� <br /> Print Name: Signature: Date: <br /> Print Name: Signatur : Date: <br /> Print Name: Signature: Date: <br /> F♦DEVSVSV Ia"W Appllcawn Fo A WSubdiNsbn(Rev.12460{) Page 7 of 9 <br />