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APPLICATION - MINOR SUBDIVISION <br /> . SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` FILE NUMBER: MS - <br /> `./F <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am (check one): <br /> EI Legal property owner (owner includes partner, trustee, grantor, 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 properties 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. <br /> Print Name: Joseph Roche Signature: or,4 Date: — <br /> oa- <br /> Print Name: Cheryl J. Roche Signature: Date: <br /> Print Name: Joe L. Dutra, Jr. Signature: - Date: —U <br /> Print Name: Jill R. Dutra Signature: *�'z <br /> ( _ Date: <br /> F:\DEVSVS\Planning Applimuon FonnsWinor Subdivision(Rev.6-03-06) Page 7 of 9 <br />