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F. <br /> 4~ <br /> 1 <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 4lJ.TH0RiZ4TI0N:sIGNATURES <br /> :AONIYYH>::QWt�EFt-C1F7NE:pROPERTYORaN'AUTHORIZE[).AGENT'MAY'FIL>*AN.APPLlCAT10N <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officels and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> I,further, certify under penalty of perjury that I am(check one): <br /> C>Q Legai property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)Involved in <br /> this application,or <br /> Q Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalr.,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: Z-65-77L- �t �} Signature: L �C Z ! C f t }��r'C-t Date: <br /> -- <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> Print Name: Signature: Date: <br /> r <br /> i <br /> 4 <br /> t <br /> 1 <br /> f <br /> r <br /> -4- <br />