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' APPLICATION - MIN01 SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> • .:. ... ..:: .::.. ::- '..'.i.; :..:.. .:.::: '.....:-:.- :n ...........T::i?4ria moi:'$:JCS't:?YJG?Y::ti:,'!.•S•%;Y.•{YG i�f`�i'i�'?:jJ,;',i:i <br /> - >: ..::..: - �A .SIO14AWIM �•..;^ h¢`'?i !/6ai 1:47tr5iw :>a'v:Qe''''e:'G2?i>•`3.5'F'w':'•i?:tt..'9!h?rr'f!iY ... <br /> ONLY THE OWNER O6:THE PROPERTY..0 -AM4OI�iZIE-A ENT M AY FiLAPPLICATION .::...: ..... <br /> I,the Owner/Agent 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,further, certify under penalty of perjury that I am(check one): <br /> ❑ 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 /> Print Name: �� ��T �V�� Signature: � � Vat _ <br /> Print Name: Signature: !Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> Print Name: Signature: Date: <br /> -s- <br />