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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AIV AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> 1, the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action or <br /> proceeding against the Owner/Agent's project. <br /> 1,further, certify u`nd/er penalty of perjury that I am(check one): <br /> ,$1 Legal property owner(owner includes partner,trustee,trustor,or corporate officer)of the property(s)Involved In this <br /> J ` application,or <br /> 0 Legal agent(attach proof of the owner's consent to the application of the property's involved in this application and <br /> have been authorized to file on their behalf.,and that the foregoing application statements are true and correct. <br /> Print Name: �O�\ r0 ��7 SS�� Signature: C- Date: <br /> Signature: Date: <br /> Print Name; Date: <br /> /yynature: <br /> Print Name: s3/ynature: Data: <br /> Print Name: S/ nature: Date: <br /> Print Name: <br /> N,HORIu MPP IORN REV. 1-10-01 (IND) -5- <br />