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p4u{" APPLICATION - MINOR SUBDIVISION <br /> P: <br /> SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> 9�rFOit� <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, <br /> action or proceeding against 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 /> authorizedtoto file on their behalf. and that the foregoing application statements are true and correct. <br /> Print Name: �h 0 ffM 4j a. q o/'S L Signature: � ��(�L_ Date: 9/04 <br /> l 4 <br /> Print Name: J3rew-(d L. 14orS/Q.n Signature: ate: <br /> Print Name: —� Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F?DEVSVSV'lanning Application FonnsVAinor Subdivision(Rev.12-09-04) Page 7 of 9 <br />