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APPLICATION - MAJO"UBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 0-4. <br /> FILE NO: MS- <br /> AUTHORIZATION SK;NATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FRE AN APPLICATION. <br /> I.Ure OwrwyAgent agree,lo delmd. YWemrity,end hold harmless the County and ss agents,officers and empbyees from any claim, <br /> action or proceeding against the OernsdAganfs project. <br /> I t xvw certify,under pare"of perjury.that I am(heck one): <br /> ® Legal property owner(owner indudes Partner,tnnLee,grerrWr,a corporate officer)of the property(s)krvdved in this <br /> application,or <br /> Cl Lepel spent(attsch Proof of the owrw§oonsent to the appficeflon of dw property's involved in this app&ceflon and have been <br /> aut"trere,'d tD Nle on their behalf. <br /> sand thatlk� <br /> the foregoing eppticnte <br /> �stamennd ts am Mo ecared. <br /> Print Name: 1 -/ftR���� /Ty�-n�7/ Signature: <br /> Prim Nara: A m A r D Ef P k tJ�2u Signature: 31 <br /> ,df* � na•yu kk Data: <br /> Print Name: Signature: Date: <br /> Print Name: signature: gate: <br /> Print Name: signature: Date: <br /> - DEvsysv+. V Mpbcw^For s"A non sueorvmsror+Ps c-os-al Page 7 of 9 <br />