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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNr Y DEVELOPMENT DEPARTMENT <br /> AUTHORIZPFTKWSIGNAT URES.; <br /> ONLY THE:OWNER OF THE PROPEE2T Y CRAtkAUTEiOR1ZEDAGE14T MAY FILE AN APPLICATION. <br /> I,the OwnerlAgent agree,to defend,Indemnify,and hold harmless the County and its agents,officers and employees from any claim,action <br /> ior proceeding against the Owner/Agent's project. <br /> I, further, certify under penalty of perjury that I am(check one): <br /> Q Legal property owner(owner includes partner,trustee,trustor,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 property's 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 /> Signature: J, /B 1/Z�l 1y <br /> Print Name: Cc, 1,2 f'. `U✓ \bc� Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> I <br />