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r . APPLICATION - MINCR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I,theOwner/Agent agree,to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, Ii <br /> action or proceeding against the Owner/Agent's project. <br /> I fur <br /> ther certify, under penalty of perjury,that I am (check one): �! <br /> egal property owner(owner includes partner.trustee, grantor,or corporate officer)of the property(s)involved in this <br /> or i <br /> �I ❑ Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and have been II <br /> !II authorized to file on their behalf., and that the foregoing application statements are true and correct. <br /> 1-2'5-C k <br /> LM wCti L {. �,t� l��fc f------ Date: <br /> Print Name: Signature: �� <br /> Print Name: - � Signature: — ti .— Date. <br /> t <br /> 1� Signature: —_ _ —___ Date: !� <br /> iI Print Name: — — 9 -—— <br /> Date: <br /> Signature: I� <br /> I Print Name: —----- ------- ------- --— i{ <br /> Signature: —_ __ —___— Date- <br /> Print <br /> ate <br /> Print Name: _ _A <br /> Pa e7of9 <br /> F'0EVSVS\P1ann+ng Application FormsWinor Subdivision(Rev 12-09-04) g <br />