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APPLICATION MINOR SUBDIVISION <br /> y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> -- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> 1,the Owner/Agent agree,to defend,indemnify,and told harmless the County and its agents,officers and employees from any claim. <br /> action or proceeding against the County arising from the Owner/Agent's project. <br /> 1 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 /> Date: 20 <br /> Print Name: L 1/ 0 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> + R tTy bCos eR fo 6Gassna via pane <br /> ye <br /> 0. /"[ irr/ipCi � it1 SiOPi <br /> � F. <br /> acef Pr►oc � <br /> f aP <br /> rr► a _-Q'r1� O.Aer PICA eps re 199 Ivyl9 fa Sac ori' is <br /> �a,,;� �, n__ �-y 1W e --E-°�� L�i�r���. � �•e��t,�fatcy�,m h�r�k+�- - <br /> .�`tie <br /> .10 <br /> F;IDEVaVS\Planning Appikarion Fo s\Mbwr SubdlvWon(Rev.05.11-09) Page 7 of 9 <br />