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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNfTY DEVELOPMENT DEPARTMENT <br /> AITTHORMAnON SIGNATURES <br /> ONLY.THE:OWNER OFTHE.PROPERTY.(3KAi*AUTFIOR=.AGE NTMAY FILE AN,APPLICATION.. <br /> I,the Owner/Agent agree,to defend,Indemnify,ar.4 hold harmless the County and its-jgeMs,officers and employees from any claim, action <br /> or proceeding against the Owner/Agent's project <br /> t,further, certify under penalty of perjury that 1 am(check one): <br /> 0 Legal property owner%)wner includes partner,trustee,tri tor,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. / C1,4 izc rZ i-Z C 1: r E a ,n c i��e e 6e t Lt�J {c. C,,C'f- Qt;, V-4 <br /> T rz r <br /> Print Name: f V QW e,, —1-c A-Oto E'1-Z Signature: /1���•� � w �� Date: <br /> Print Name: _ Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> f <br />