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i <br /> APPLICATION -- MAJOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> I <br /> wp <br /> 4[ z <br /> I. r �". N � ` � EPR Rf� �t��•� �I ��,F p� z� w"�` .r �.� <br /> �.�� : T Ei�� ,�? ..... -.,. R' ,O! �,�N`'�4FJ�-,�_ .... � �E.N��M'�. ��=�`"�I1.'�,p►�P�fG'�A'GiC7� �.«,�. <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 /> c <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 /> i are true and correct. <br /> Print Name � C' Z: =L Signature: C Date: <br /> Print Name: Signature: Date: <br />'. Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> r <br /> i <br /> i <br /> i <br /> I <br /> I <br /> F:\DEVSVC\Planning Application FormsWinor Subdivision (Rev.6-03-04) Page 7 of 9 I <br />