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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> CI' �P <br /> C it 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 1 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: _i i M `/- he:-» nv Signature: Date: <br /> Print Name: JoG�� rT�• ► �w "� Signature: Date: <br /> Print Name: t �� g -�` <br /> „�m-� nature:Si Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> F:\0EVSVS\Planning Application FormsWinor Subdivision(Rev.12-09.04) Page 7 of 9 <br />