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APPLICATION - MINOR SUBDIVISION <br /> ";�� `I SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Al _. f <br /> FILE NO: MS- <br /> � OR <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 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:Monty A.Vander Beek,Trustee Signature: y' '' �' Dale: <br /> Print Name: Karen J.Vander Beek,Trustee Signature:' / ;L4Print Name: Jerry M. Vander Beek.Trustee Signatureate <br /> Print Name: Patricia M.Vander Beek, Trustee Signature: Date: <br /> Print Name: Signature: Date: <br /> Fr\DEVSVS\Planning Application FonnSWinor Subdivision(Rev.12-09-04) Page 5 of 5 Job No.2006-118 Minor Sub <br />