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�q ui(y <br /> APPLICATION - MINOR SUBDIVISION <br /> r: z <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> J FILE NO: MS- <br /> ..CQ`FOR�`4 <br /> - AUTHORIZATION SIGNATURES <br /> �-MAL <br /> 1114112-11PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> "s .. h <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 /> 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 s Cements are true and correct. <br /> Print Name:�3-�`��f � �� Signature: Date: 2 -� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: _ _ Date: <br /> Print Name: Signature: Date: <br /> F:IDEVSVS%Planning Application FormsWinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />