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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> fl,theOwner/Agent agree,to defend, indemnify,and hold harmless the County and its agents,officers and employees from any claim, <br /> 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 /> authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: L ;L/:IV 4, h, Y_l�ICfL' Signature: //61--Date: q'� <br /> Print Name: ` • �� "C!tf , .I"-L�y <br /> Signature: 1s �? �fu /� <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\DEVSVS\Planning Application Forms\Minor Subdivision(Rev.6-03-04) Page 7 of 9 <br />