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Rqui APPLICATION - MINER SUBDIVISION <br /> �) SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> t <br /> P' FILE NO: MS- <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 Owner/Agent's project. <br /> I further certify, under penalty of perjury, that I am(check one): <br /> `�9� 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 11their behalf.,and that the foregoing application statements are true and correct. /� <br /> Print Name�O�et2t Signature: v Date -2�C'Z�Cl <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Appki bon Fonns\Minor Subdivision(Rev.12-09-04) Page 7 of 9 <br />