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AQUtN <br /> °mac° APPLICATION - MINOR SUBDIVISION <br /> .G <br /> f SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N: { <br /> •' FILE NO: MS- <br /> 4;0 <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 County arising from 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: Fo tie_t� V� -k G(-C rNt q,--rl Signature: - Date: <br /> Print Name: -1)311 V&11- &ro 11'i tq-e-Ix Signature: s v l "YZ Date: <br /> Print Name: 7e)6 A VA vi Cz ro(I e 11 Signature: ^ V C Date: <br /> Print Name: tAa( y I V1_ Vd r1 Cil Signature: L Date: <br /> Print Name: 13a IL \J8 i t G4-C I IVgE_r1 Signature: <4,7-1 Date: <br /> J d S ce, V t i <br /> (SLro n. ,Lj 2vl <br /> F TEVSVS\Planning Application Forms\Minor Subdivision(Rev 2-1-11) Page 7 of 9 <br />