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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> r <br /> LEAN AP <br /> 1, 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 OwnerlAgent'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: ROSALINA C. LUIS,TRUSTEE Signature: Date: <br /> Print Name: Signature; <br /> Date: <br /> Print Name: Signature: Date, <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FADEVSVS\FWn1n9 Appricaflon Foms\Mhor Subdivision(Rev,12-02-M) Page 7 of 9 <br />