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c <br /> APPLICATION <br /> MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SiGNATUR S <br /> QNLY1HE:Ov11NER OF:THE'P}70PERTY dR 4N'AUTFidRIZFn-AGENT: <br /> 141�kY FILE)4N:AFPLICATTON <br /> .. I <br /> 1,the Owner/Agent agree,to defend,Indemnity,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project <br /> I,further, certify under penalty of perjury that I am(check one}: <br /> c4X Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)involved in <br /> this application,or <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 /> I <br /> V �to by <br /> Print Name: V E Signature: Date: Z 2-6 19 <br /> Print Name: (�rl qtr +0 Signature: y !!' <br /> Date, ;?6 �= n <br /> Print Name: z2Jdi s /✓f fl�l�_ .,.._ Signature: _ ,�s�' Date: %2 <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> a <br /> 1 <br /> I <br /> I <br /> t <br /> y� <br /> h <br /> Ii <br /> r <br />