Laserfiche WebLink
APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ;! <br /> pUTHORIZA7iQN SKMATUREs . <br /> ONLY THE OMmk r-TNE.PROPERTY OR AN AUTHORITE'AGENT MAY'AM A1�RPPGICATIOI <br /> I,the OwnertAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against 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,trustor,or corporate officer)of time property(s)Involved In <br /> this application,or <br /> Q Legal agent(attach proof of the owner's consent to the application of the property$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: MC47 ,1d -0 date: <br /> Print Name: Signature: Date: <br /> 1� z <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> is <br /> -5- <br />