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APPLICATION - MINOR SUBDIVISION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FILE NO: MS- <br /> AUTHORIZATION SIGNATURES <br /> ONLY THE OWNER OF THE PROPERTY OR AN AUTHORIZED AGENT MAY FILE AN APPLICATION. <br /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees <br /> from any claim, action 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, grantor or corporate officer) of the property(s) involved <br /> X <br /> in 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 JI,VII P S cr> <br /> Name. f <br /> Signature: tAA�L,.y�� C f r •���� <br /> Date: <br /> Print <br /> Name: <br /> Signature: <br /> Date: <br /> Print <br /> Name: <br /> Signature: <br /> Date: <br /> Print <br /> Name: <br /> Signature: <br /> Date: <br /> Print <br /> Name: <br /> Signature <br /> Date: <br /> F:DEVSVS/Planning Application Forms/ <br /> Minor Subdivision <br /> (Revised 06-03-04) Page 5 Of 5 <br /> Job No 2004-155 <br />