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A4U1" 'APPLICATION - MAJOR SUBDIVISION <br /> N'-. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> i9 FILE NO: MS- <br /> 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, indemnity, 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 /> 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: M__i-„ Ch-i � i r.., Signature: U.-.."s C-�-�– Date: $=i Jr-O 5– <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSV&PIanning Appkation For MMAJOR SUBDIVISION(Rev.6-03-04) Page 7 of 9 <br />