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APPLICATION-MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTYCOMMuNITYAEvELOPMENT DEPARTMENT <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN 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 tram any claim,action or <br /> proceeding against 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 /> 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 th oregoIng application statements are true and correct. <br /> Print Name: Zrlqi 15 Signal Date: <br /> j <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> i <br /> i <br /> I <br /> i <br /> 14IN0ti5[IBAP? FORM HHV, 8-10-01 (INO) <br />