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UrN APPLICATION- - MINOR SUBDIVISION <br /> r' <br /> PSAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; X <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES- <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED-AGENT MAY FILE AN APPLICATION. <br /> I,the Owner/Agent agree,to defend, indemnify, and hold harmless the County and itsagents, officers and employees from any claim, <br /> action or proceeding against the County arising from the Owner/Agents project. <br /> I further certify, under penalty of perjury,that I am (check one): <br /> m Legal property owner(owner includes partner, trustee, grantor,or corporate officer)of the property(s) involved in this <br /> application,or <br /> ❑ Legal agent(attach proof of the owners consent to the application of the property's involved in this application and have been <br /> authorized to file on their behalf., and that the foregoing application statements are true and correct. <br /> Print Name: _ t� J�Vl�� Signature: Date: I OI I�1t� <br /> Print Name: Signatur Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: .Date: � <br /> FIDEVSVS%PIanning Application FonnsWinor Subdivision(Rev 2-1-11) Page 7 of 9 <br />