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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> AUMORfZk'EIOKstax/kTURE <br /> ONLY THE OWN E}�OE THE PROP£RTYdst.-X tAU7HORRE 4dENTMAY FTLE Af 4 APP41CAT10N <br /> I,the OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and Its agents,officers and employees from any claim,action <br /> or proceeding against the Owner/Agent's project. <br /> ' I <br /> I, further, certify under penalty of perjury that I am(check one): <br /> i <br /> I2 Legal property owner(owner Includes partner,trustee,trustor,or corporate officer)of the property(s)involved in <br /> this application,or <br /> Q Legal agent(attach proof of the owner's consent to the application of the property's Involved In this application <br /> and have been authorized to Rio on their behalf,and that the foregoing application statements are true and <br /> correct. <br /> Print Name: AC�c7 � n/C-�j Signature: Z� �+�\/��e-� ��': Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br />