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APPLICATION - MINOR SUBDIVISION <br /> NVAPPLICATION <br /> JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ::,� `4`• RLNiJfEd�,P�l.tl : <br /> FILE NO: III <br /> rIFOPW 3 <br /> t , ^P' YFY SIS Ort' 0 lA` C A Y.?RYFPF "'t � q <br /> ONLY TFIfi:OWNER OF THE PRPERTy OR�4NUT OR)ZED,AGENT?MgY F{I, ASN APFLIflt N <br /> I,the Owner/Agent agree,to defend,indemnity,and hold harmless the County and its agents,officers and employees from any claim, <br /> action or proceeding against the County arising from the Owner/Agent's project <br /> 1 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 owners 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: Li'l yreii L(.��0/10 Signature: Date: <br /> Print Name: � / OOPT Signature: ^-� Date: t2^—!6 /G <br /> Print Name: 5hw f/ Signature: % Date: -i- ---%- (p <br /> Print Name: _VickSignature: Date: ��� 17 <br /> Print Name: / O& - _W n/ C Signature: -Date: f/W- <br /> Civ rrx_ (-dZPW if <br /> 19 <br /> F:VJEVSVSWlanrung Applicatlan Fcnn&%Minar Subdivision(Rev.05-11-09) Page 7 of 9 <br />