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r - E <br /> APPLICATION <br /> - MINOR SUBDIVISION <br /> 0 i +� SAN JOAQL.IIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT � <br /> WI .' FILE NO: MS---------------__--- <br /> • <br /> -AUTHORIZATION SIGNATURES . I <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1 <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 /> t <br /> Legal property owner(owner includes partner,trustee, grantor,or corporate officer)of the property(s)involved int is <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 true and correct. <br /> Signature: a-�- r-. c�.� Date: 7- 96 <br /> Print Name: e1 ti a 9 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F%DEVSVS%Fanning Application FormslMinor Subdivision(Rev,6-03-04) Page 7 of 9 <br /> F <br />