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- r <br /> APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �diys'a`'`P FILE NUMBER: MS - <br /> r, <br /> --------------- <br /> AUTHORIZATION SIGNATURES <br /> ONLY.THE O _.�J O. TH O ,ERTY OR AN AUTHORIZED AGENT MAY FILE AN APP7and <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers <br /> employees from any claim, action or proceeding against the Owner/Agent's project. <br /> 1, further,certify under penalty of perjury that I am (check one): <br /> R 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: Date: — <br /> Print Name: Cheryl J. Roche Signature: Date: <br /> Print Name: Joe L. Dutra, Jr. Signature: Date: <br /> Print Name: Jill R. Dutra Signature: Date:4 <br /> F\13EVSVS0.l ning Applkarion FormsWinor Subdivision(Rev.6-03-04) Page 7of9 <br />