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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <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,action or <br /> proceeding against the Owner/Agent's project. <br /> I further certify, under penalty of perjury, that I am(check one): <br /> O Legal property owner(owner includes partner, trustee,grantor, or corporate officer)of the property(s)involved in this <br /> fapplication, or <br /> J Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> l _ have been authorized to file on their behalf.,and that the yegoing a Iication statements are true and correct. <br /> Print Name:-un. -r `Signature: Date: <br /> Print Name: r y Ct f G �,l t �t Signature: i� Date: <br /> Print Name: Signature: Date: <br /> Prins Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> MINORSUSAPP FCRM REV. d-10.01 IIHDI <br />