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a: f 7T <br /> - <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHOR[ZATIO SIGIVAiUI E'S <br /> ONLY THE OWNEROF TWE PROPERTY OR AN AEITHORIZED, GENT MAY FILe'AN>;%rPdCATICW <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> 1,further, certify under penalty of perjury that I am(check one): <br /> C) Legal property owner(owner Includes partner,trustee,trustor,or corporate ofitcerl of the property(s)Involved In <br /> this application,or <br /> Legal agent{attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: Dqvon L LoNC,t <br /> Signature: <br /> Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name; <br /> Signature: Date: <br /> Print Name: <br /> Signature: Date: <br /> Print Name: <br /> Signature: <br /> Date: <br /> i <br /> i <br /> i <br /> I <br /> 1 <br /> I <br /> -5- <br />