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APPLICATION - MINOR SUBDIVISION <br /> SAN JCAQUIN CCUNTY COMMUNITY DEVELOPMENT CEF.AR7NIENT <br /> ka <br /> FILE NO: MS ------------------- <br /> �.- <br /> O <br /> rl. <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 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 /> F1 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 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: r-.re Ley,-)rr l] Signature: 101t� Date: j1117le'J <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F 1DEVSVS1PIannmg Application Forms%hhnor Scbdrvision(Rev 6-03-04) Page 7 of 9 <br />