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f <br /> APPLICATION - MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE N0: MS- <br /> a <br /> c <br /> i __ -.rs ` ,.. ,. A f - W <br /> " ,` 4 £ A <br /> } - = F T. E Pt �PER� �l ��► E L._ - _P1�.ICAT[C N <br /> immm""st <br /> agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> y claim, 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 owners (owner includes partner, trustee, trustor, or corporate officer)of the property(s) <br /> involved in this application, or <br /> ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this <br /> application and have been authorized to file on their behalf, and that the foregoing application statements - <br /> are true and correct. <br /> Print Name: s�ZA-!C"S--r Signature: - c Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Dater <br /> s FADEVSVGIPlanning Application Forms\Minor Subdivision;Rev. 6-03 04) Page 7 of 9 <br />