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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZA71ON SIGNATURES <br /> ONLY THE O"EROFTHEPROPERTYORANAUTHORIZEDAGENTMAYFILEAN APPLICATION. <br /> 1, the Owner/Agent agree,to defend,IndemnlfY,and hold harmless the County and Its agents,ofRcers and employees from any claim,action or <br /> Proceeding against the OwnenAgent's project. ._ . <br /> 1, further, certify under penalty of perjury that I am(check one). <br /> 0 Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> application,or <br /> O Laga/agent(attach proof of the owner's consent to the application ofthe property's Involved In this application and <br /> q have been authorized to Me on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Nam e,YLLeifu�_-�d rzAt. dd��ly, L�c,Slgnaturo:� Lu �1 l G.tM�v y <br /> Print Name: Date:. y -S—a, <br /> Signature: <br /> PnnLNamer Date: <br /> Print Namu alyneturor Dater <br /> Print Name: " a 3 1 ntgnaature:turo: Dater <br /> Date: <br /> a <br /> erwuuwr row rev. .,0.., I[xcl ,. <br />