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f r <br /> LJ <br /> APPLICATION - MINOR SUBDIVISION <br /> 'i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN'AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I,the OwnerlAgent agree,to defend,indemnify,and hold,harmless the County and its agents,officers and employees from any claim, action or <br /> 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 consent5to 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 /> Date: <br /> Print Name: �{ !`�2�} �J, C_�/"i. Signature: <br /> Print Name: Signature: Date: <br /> Print Name- Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: 5ignature: Date: <br /> . s <br /> I <br /> ' <br /> F.11DEVSV51lP1a1ning Application FormsllMinor Suhdivisian(Rev.12-04-04) <br /> Page 7 of 9 <br /> a <br />