Laserfiche WebLink
r !VISION <br /> APPLICATION - MINOR SUBD <br /> 4 y `�: ! SAN JOAQUiN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> r I, the Owner/Agent agree,to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, <br /> action or proceeding against the Owner/Agent's project. <br /> I further certify, under penalty of perjury, that I am(check one): <br /> � III <br /> Legal property owner(owner includes partner,trustee, grantor, or corporate officer)of the property(s)involved in this <br /> t application, or <br /> i <br /> ❑ Legal agent(attach proof of the owner's 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: Signature: <br /> ' Date: <br /> Print Name: _ Q?)u � ��Cy/� �S Signature: a <br /> - mss <br /> Print <br /> N ,/• <br /> ame. Signature: <br /> Date: <br /> Print Name: <br /> Signature: <br /> Date: <br /> Prrnt Name: Signature: <br /> Date: <br /> 0 <br /> � I <br /> 3 ! <br /> t� <br /> € <br /> I <br /> Y ' <br /> I <br /> 3 <br /> �I <br /> i <br /> I <br /> FADEVSVMPIanningApplicationFormsWinorSubdivision(Rev.6-03-04) Page 7 of 9 <br /> � I <br /> t � <br />