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4Ur" APPLICATION MINOR SUBDIVISION <br /> - <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> C�"Q(r p ORN�P <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 County arising from 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 <br /> /true and correct. <br /> Print Name: Signature: vL�^��"+ Date: 12/fo�15 <br /> Print Name: Signature: Date. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> RTEMS\Planning Application FormsWlinor Subdivision(Rev.05-11-09) Page 7 of 9 <br />