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A <br /> I: <br /> I <br /> APPLICATION -. MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVE�OPM�NT Dl=PARTMENT <br /> 1��,�1 S ti1ltY`��''•��a�•3)a�K'?�;<f<s< r':' � <br /> t i-0. s n { {>3 •a <br /> AttTHORtIA710NcS1�NATUR♦=�5' <br /> •" ,�:;,bN�YE`.O f?ifiO �E:pf#OPERTYt}I�AN,��t11'NOR?���d�tJ FLE`APrPtI A710N <br /> f,the DwnerlAgertt agree,to defend,Indemnity,and hold ttarmies=the County and Its agents,otJlce s and em n va <br /> or proceedln�agalnat the OwnerlAgent's project <br /> I employees from any claim,action <br /> I,further, certlry,u�n//der penalty of perjury that I am(check one): <br /> F� legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(3)Involved In <br /> this application,or <br /> Legal agent{attach to the PP <br /> and have been authorized to Ilia on their behalf., <br /> and that that fotregoing apon of the plicaatioonn ata amen s are3 involved Iry ttme and tion <br /> correct <br /> Print Name: <br /> Print Name: Signature: Date. e'ij <br /> (- <br /> Signature: <br /> Print Name: ate. 9-//-,03 <br /> Signature: <br /> Print Name: Date: <br /> Signature: <br /> Print Name: Date: <br /> Signature- <br /> Date: <br /> I: <br /> li <br /> I <br /> ,1 <br /> II <br /> ' I <br /> I <br /> I <br /> 'i <br />