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APPLICATION - MAJOR SUBDIVISION <br /> 1 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> ONI.X T►i GIW ' l�UTW # N. NT;MAXfll��.lt <br /> f,the Owner/Agent agree, to defend,indemnify,and hold harmless the County and its agents,officers and employees tram any claim. <br /> action or proceeding against the Owner/Auent's project. <br /> I further certify, under penalty of perjury,that l am(check one): <br /> ALegal property owner(owner inoludos partner,trustee,grantor,or corporate officer)of the property(s)involved in Qua <br /> application,or <br /> ❑ Legal agent(attach proof of the Owners consent to the application of the property's involved in this application arW have been <br /> authorized to file on their behalf.,and that the foregoing application statements are true and corracL <br /> Print Name: Signature: Data: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> FODEVSVS4)WMWQ Appicebun FDnn6V"wOR SUBDIVISION(Rev,6-03-04) Page 7 of 9 <br />