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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMEN DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, 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 OwnerlAgent's project. <br /> I further certify, under penalty of perjury, that I am(check one): <br /> Legal properly owner(owner Includes partner, trustee,grantor,or corporate officer)of the properly(s)Involved in this <br /> application, or <br /> 0 Legal agent(attach proof of the owner's c ent to the application of the property's Involved In this application and <br /> have been authorized to/Ile on their be alf.,a that the foregoing application statements are true and correct. <br /> Print Name: �i I <br /> Signature: Date: <br /> Print Name: <br /> ` C+� Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> Print Name: Signature: <br /> Date: <br /> NINCRSVBAPP PORN RF.V, l-10-01 IIH�) <br /> 'S- <br />