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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELORMENT DEPARTMENT <br /> C`A`t10N.:. ,.. <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its agents,offtcefs and employees from any claim,action <br /> or proceedln,g against the OwnerlAgent's project. <br /> I,further, certify under penalty of perjury that I,am(check one): <br /> a Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In <br /> this application,or <br /> O Legal agent(attach proof of the owner's consent to the appilcadon of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct <br /> Print Name: EN : Signature: u Date: 1,/—/— 60 <br /> Print Name: NIG�OL ,�j i✓0 Signatur •, Date: o-'' <br /> Print Name: Signature: Date: <br /> I Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> C <br /> -4- <br />