Laserfiche WebLink
4 MINOR SUBDIVISION <br /> APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> -T '0YR bf,-TtF0PQ -jVTRQR EMT:MY. �� <br /> : <br /> ; . VN _ j . -R P _ Ak .11 .AhFLICAT10 <br /> 1,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 County arising from the Owner/Agent's project. <br /> I 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 /> El 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: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature Date: <br /> FADEMWisming Appncaflon FormsWinor Subdivision(Rev.05-11-09) Page 7 of 9 <br />