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r <br /> *APPLICATION - MINOR SUBDIVISION <br /> SAN JOA UIN COUNTY COMMUNITY DEVELO <br /> „w FILE NO: MS- <br /> '9 6 <br /> S-Kc <br /> _ AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE 'PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the 0•er/Agent agree,to defend, indemnify, a'nd hold harmless the County and agerst officers and em loyees from a=laim,, <br /> action or proceeding against the Co�1ty arisin from the Owner/Agent's project. <br /> •fTeMrcertifv, under penalty of perjury,that I am (check one): <br /> tliisV <br /> JLegal property owner(owner Includes partner,t�+ rantor, or corporate Officer)of the property(s)invove m <br /> application, or �� a <br /> �, <br /> Legal agent(attach proof of the owners consent to the application of the property's icnvolved in is application an aTe been <br /> authorized to file an their behalf., and that the foregoing application statements ire tr and cors <br /> • � G� Si nature: % -, •- Da <br /> Print Name: 'cLivK�r'2Y c " <br /> Signatu� <br /> Pnn a <br /> Print Na <br /> Sign atura: Date <br /> ii <br /> I na ure. <br /> ac <br /> P t� • � ate, <br /> Print Name: Signature - <br /> Page 7 0 90 <br /> F:1orvsyslPlannincg Application Fotmsll',�unor a div 7mn{Rev.05 11-09) 0 <br />