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t . <br /> APPLICATION -- MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> - 1�lY.��tt1r,QN . . F�TWE 1��PER= � �Ql�� ,�ti�JTH ,;t2EN��GEtW�i'IIIYAY�F �.E"A,�;�PP�ICAt"�101 - �.r� <br /> I, the OwnerlAgent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> Employees from any claim, action or proceeding against the Owner/Agent's project. <br /> i <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 /> I �^ <br /> Print Name: talC` -T C CsL Signature: C c Date: G7� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> i <br /> 1 <br />++ F: v V PI <br /> 4 IDE S C1 arming Application PormslMiner Subdivision Rev. 6-03-04) Page 7 of 9 <br />