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C°P APPLICATION - MINOR SUBDIVISION <br /> „fi <) SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> — FILE FILE NO: MS- <br /> 9��FOR� <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 /> (g 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: Bow C4-- L i'rc.$ Signature: Date: alIA106 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F oEvsvSWlannhg Application Forms\Minor Subdivision(Rev.12-09-04) Page 7 of 9 <br />