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" APPLICATION - MINOR SUBDIVISION <br /> r K SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> •f <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 /> ® 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 owners consent to the application of the propertys involved in this application and have been <br /> authorized to file on their behalf.,and that the foregoing application <br /> statements are true and correct. <br /> Print Name: V1L �• �A�V{�iY� signature;re: <br /> Date: 7 - L.y—,7 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F?DEVSMManning Application Fo sWlnw Subdivision(Rev.12-09 g4) Page 7 of 9 <br />