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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUl71401 ZATlbiil SiDtilA7llRES <br /> oN1.YTHEOVYIVERO :THi:PIiOpERTY,i�RA1. E7i4�Efd3MAYEILEAFf:,APPf.ICATION .. .;:> <br /> 1,the owner/Agent agree,to defend,Indemnify,and hold harmless the County .. <br /> and its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Ag ant's project. <br /> I,further, certify under penalty of perjury that I am{check one): <br /> Ij <br /> ❑ LegaL property owner{owner Includes partner,trustee,trustor,or corporate officer)or the property(s)Involved In <br /> this application,or <br /> i <br /> ❑ Legal agent(attach proof of the owner`s consent to the application of the property's Involved in this application <br /> and have been authorized to file on their behalf.,and that the foregoing application statements are true and <br /> correct. <br /> it <br /> I! <br /> Print Name: 2 (O r2 C Signature: Date: <br /> Print Name: a Signature: Date. <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> 0 <br /> i <br /> li <br /> 'I <br /> I� <br /> w <br /> II <br /> !I <br /> � A <br /> 1 II 1 <br /> L fl <br /> -S_ <br />